Math Flashcards by His S

What molar ratio (salt:acid) would be required to make a buffer solution of sodium acetate and acetic acid with pH of 5.76. The pKa of acetic acid is 4.76. (Round to nearest WHOLE number)

10:1

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CB is a patient on the medical floor. Earlier today D5 1/2NS + 40 mEq KCl was ordered to run at 75 ml/hr. Unfortunately@ an error was made and her 1 liter bag has been running at only 45 ml/hr for the past 4 hours. How many extra mEq of KCl will CB need to receive now to equal what she would have gotten if the drip had been hanging at the correct rate for the past 4 hours? (Round to nearest TENTH)

4.8 mEq

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JM is a patient in the ICU (6’1” and 256 pounds). He is currently receiving a 3-in-1 PN at 115 mL/hr. The PN is 12.1% w/v dextrose and 4.7% w/v protein. The prescriber wants the patient’s protein intake from the PN to be 1.2 g/kg IBW per day. By how many grams will the current protein content need to be reduced to achieve this? (Round to nearest WHOLE number.)

34 g

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How many milliliters of a 1:5000 (w/v) solution of boric acid can be made from 50 ml of a 0.4% solution? (Round to nearest WHOLE number)

1000 ml

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TH requires 1.5 g/kg/day of protein (based on his total body weight), which will be provided by Aminosyn 15%. TH is a 62-year-old male (weight 89 kg, height 6’2”) who is confined to bed (activity factor 1.2) due to severe pneumonia (stress factor 1.6). How many milliliters of Aminosyn 15% should he receive? (Round to nearest WHOLE number)

890 ml

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The clinical pharmacist in the Pediatric ICU is asked to determine what rate to run a child’s IV at. The IV contains 9 ml of 39.2% potassium acetate in normal saline to prepare a 1 l bag. The prescriber wants the child to receive 2.5 mEq/hr of potassium acetate. (MW of K=39; MW of acetate=59). What rate (in ml/hr) would provide the desired mEq/hr of potassium acetate? (Round to nearest WHOLE number)

69 ml/hr

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Express 1:5000 as a percentage strength. (Round to nearest HUNDREDTH)

0.02%

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A pharmacist has a prescription for 30 ml of an eye drop that is to contain benzalkonium chloride 1:750 as a preservative. On the shelf the pharmacist finds 17% benzalkonium chloride. Using a dropper that delivers 25 drops/ml, how many drops will be required to prepare this compound formula? (Round to nearest WHOLE number)

6 drops

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CB is receiving 1,150 ml of D30W, 860 ml of Aminosyn 8.5%, and 340 ml of Intralipid 10% in his PN. What percentage of the non-protein calories are represented by dextrose? (Round to nearest WHOLE number)

76%

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A pharmacist is asked to compound 60 ml of an isotonic eye drop. Drug X (a liquid with an E-value of 0.33) and sodium chloride will be used to prepare a final concentration of 1:500 (w/v). How many milligrams of sodium chloride must be added to make the eye drops isotonic? (Round to nearest WHOLE number)

500 ml

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A patient has been receiving 400 ml of an enteral mixture that contains532 mOsm/l. The pharmacist will reduce the contents to 380 mOsm/l. How many milliliters of bacteriostatic water should be added to the current bag? (Round to nearest WHOLE number)

160 ml

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A 45 lb child with acute bacterial tonsillitis is to receive a cefdinir at 7 mg/kg/dose twice a day for 5 days. Cefdinir comes in 250 mg/5 ml oral suspension. How many milliliters will this child need per day? (Round to nearest WHOLE number)

6 ml

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A new patient is being seen today in the pharmacist-run disease state management clinic. She is from France and just moved to the US. She is very knowledgable about her medical conditions. She states that her most recent total cholesterol level was 5.2 mmol/l. The pharmacist knows that his lab reports total cholesterol in mg/dl. He looks online and determines the MW of cholesterol is 387. What is the patient’s total cholesterol in mg/dl? (Round to nearest WHOLE number)

201 mg/dl

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How many milliliters of polyethylene glycol 400 (SG=1.13) are needed to prepare a prescription that includes 54 g of the surfactant/emulsifier (polyethylene glycol)? (Round to nearest ONE DECIMAL PLACE)

47.8 ml

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A patient in the Emergency Department is receivingD5 1/4 NS + 20 mEq KCl. The 1 liter bag is being run with IV tubing that delivers 15 drops/ml. The patient has been receiving this for 8 hours at a rate of 12 drops/min. How many mEq of potassium has the patient received so far? (Round to nearest ONE DECIMAL PLACE)

7.7 mEq

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Express 660 parts per million (PPM) as a percentage. (Round to nearest THREE DECIMAL PLACES)

0.07%

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All of the epinephrine auto-injectors and prefilled syringes in the hospital have expired or been recalled. The pharmacist must use epinephrine 1:1000 for a patient having an anaphylactic reaction on the floor. The prescriber has ordered “epinephrine 0.5 mg SC stat”. How many milliliters of the available epinephrine product should be administered? (Round to nearest TENTH)

0.5 ml

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A patient is receiving 650 ml of 10% lipids. How many kcal is the patient receiving from the lipids? (Round to nearest WHOLE number)

715 kcal

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An order is written to add 600 ml of 10% amino acid solution to a PN. The only concentration in stock is 15% solution. How many milliliters of the15% solutions should the pharmacist add? (Round to nearest WHOLE number)

400 ml

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A pharmacist mixed 500 g of a liquid drug (SG = 0.662) in enough liquid to prepare 2 liters of a final product. What is the percentage strength (v/v) of the final product? (Round to nearest WHOLE number)

38%

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One gallon of hand lotion contains 472 mL of cetyl alcohol. What is the percentage (v/v) of cetyl alcohol in the lotion? (Round to nearest WHOLE number)

12%

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A hospital pharmacist receives a prescription for 3% saline for a patient in the Near ICU. The premixed 3% saline bags that the pharmacy normally stocks are on a backorder. How many milliequivalents of 23.4% NaCl will need to be added to a 1 liter bag of normal saline to prepare 3% saline for this patient? (Round to nearest TENTH)

411.8 mEq

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Express 0.5% as a ratio strength. (Round to nearest WHOLE number)

1:200

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A pharmacist receives a prescription for 1.5% (w/w) hydrocortisone cream using cold cream as the base. She will use hydrocortisone injection (100 mg/ml@ SG 1.5) to prepare the prescription because she has no hydrocortisone powder in stock. How many grams of cold cream are required to compound 60 grams of preparation?

46.5 g

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How many ml of a 1:1,250 (w/v) solution of aluminum acetate can be made from 100 ml of a 0.2% solution?

500 ml

A pharmacist will prepare an Amoxil suspension to provide a 1600 mg daily dose for a child with an otitis media infection. The dose will be divided BID. To prepare an Amoxil suspension containing 200 mg/5 ml the pharmacist should add 76 ml of water to the powder for a final volume of 100 ml. The pharmacist should add approximately 1/3 of the water first, shake vigorously, add the remaining water, and shake again to form the suspension. The pharmacist mistakenly adds too much water and finds that the final volume is 110 ml. The pharmacy has no other bottle of Amoxil, so the pharmacist will dispense the bottle with the extra water added. How many ml should the patient take twice daily to receive the correct dose? Round to nearest whole number.

22 ml

What is the ratio strength (w/v) of 50 ml containing 1:20 (w/v) ammonia solution diluted to 1 liter?

1:400

A pharmacist receives an order for sodium chloride 4 mEq/kg/day for a patient who weighs 165 pounds. Using 1/2NS, how many liters will the patient require per day? Round to nearest tenth. (MW of Na=23, MW of Cl=35.5)

3.9 l

A patient is receiving D51/2NS with potassium chloride at 20 drops/min. After 10 hours, the patient has received a total of 40 mEq of potassium chloride using tubing that delivers 15 drops/ml. What is the percentage concentration of potassium chloride in the patient's IV fluid? Round to 2 decimal places. (MW of K=39, MW of Cl=36)

0.38%

An order is written for a dopamine drip in the ICU. The order reads: "Start dopamine drip at 3 mcg/kg/min, titrate by 5 mcg/kg/min Q5 minutes to achieve SBP >100 mmHg. Page the critical care resident for additional orders if maximum dose of 20 mcg/kg/min is reached". The patient weighs 165 pounds and the ICU stocks premixed dopamine drips (400 mg/250 ml) in the automated dispensing cabinet (ADC). What rate (ml/hr) should the dopamine drip be started at? Round to nearest whole number

8 ml/hr

A 46-year-old female with radiation enteritis is receiving 1,800 kcal from her parenteral nutrition. The solution contains amino acids, dextrose, and electrolytes. There are 84.5 grams of protein in the PN and it is running at 85 ml/hour over 24 hours. What is the final concentration of dextrose in the PN solution? Express the answer as a percentage. Round to nearest whole number.

21%

ML is a 165 pound male receiving a premixed dopamine drip (400 mg/250 ml) in the ICU. The order states that the drip can be titrated to a maximum dose of 20 mcg/kg/min. What is the maximum rate (ml/hr) at which the drip can e run? Round to nearest whole number.

56 ml/hr

A pharmacist in an oncology clinic receives the following prescription for a patient with Hodgkin lymphoma: "Prednisone 40 mg/m^2/day PO on days 1-14". The patient is 5'1" and weighs 116 pounds. The hospital uses the following formula for BSA (m2)=0.007184 x height (cm)^0.725 x weight (kg)^0.425. How many 20 mg prednisone tablets should be dispensed to the patient?

60 mg/day, 3 tablets

A nephrologist is treating a patient with hyponatremia. She estimates the patient's sodium deficit to be 210 mEq. How many ml of normal saline (MW Na=23, MW Cl=35.5) will be required to replace the deficit?

1,365 ml

A pharmacy technician is asked to compound three 500 ml doses of 5% albumin. How many 50 ml vials of 25% albumin will be required?

6 vials

A patient is to receive a potassium acetate infusion prepared by adding 9 ml of 39.2% potassium acetate (KC2H3O2) to 0.45%NS to make 1 liter. The patient is to receive the potassium acetate at 5 mEq/hr. What rate in ml/hr will provide this dose? Round to nearest whole number. (MW of K=39, MW of C2H3O2=59)

139 ml/hr

An intravenous infusion contains 2 ml of a 1:1,100 (w/v) solution of epinephrine and 250 ml of D5W. At what flow rate, in ml/ml, should the infusion be administered to provide 0.3 mcg/kg/min of epinephrine to an 80 kg patient? Round to nearest whole number.

3 ml/min

A patient received 4 mg of IV morphine. What is an equivalent dose of oral hydromorphine? (10 mg of IV morphine is equivalent to 7.5 mg of oral hydromorphine)

3 mg

IF 200 capsules contain 500 mg of an active ingredient, how many milligrams of the active ingredient will 76 capsules contain?

190 mg

IF phenobarbital elixir contains 18.2 mg of phenobarbital per 5 ml, how many grams of phenobarbital would be used in preparing a pint of the elixir? Round to nearest tenth.

1.7 g

WC, a 57-year-old male, is receiving 1,145 ml of D30W, 850 ml of FreAmine 8.5%, and 350 ml of Intralipid in his PN therapy. What percentage of the non-protein calories is represented by dextrose? Round to nearest whole number.

75%

A penicillin V 250 mg tablet equals 400,000 units of penicillin activity. A patient is taking penicillin V 500 mg tablet QID for 7 days. How much penicillin activity, in units, will this patient receive in the total prescription?

22,400,000 units

A cough syrup contains 4 grams of brompheniramine maleate per liter. How many milligrams are contained in a teaspoonful dose of elixir?

20 mg

A patient is to receive acyclovir 5 mg/kg every 8 hours for an acute outbreak of herpes zoster. What daily dose@ in milligrams@ should a 110 pound female receive?

750 mg/day

MH is a 72 year old male patient hospitalized with decompensated heart failure and fever. CUlturs are positive for aspergillosis. MH weighs 110 kg and will receive 0.25 mg/kg per day of amphotericin B (reconstituted and diluted to 0.1 mg/ml) by IV infusion. How many milliliters of amphotericin solution is required to deliver the daily dose?

275 ml

Oral potassium chloride 20% solution contains 40 mEq of potassium per 15 milliliters of solution. A patient needs 25 mEq of potassium daily. What amount@ in milliliters@ of 20% potassium chloride should the patient take? Round to nearest tenth

9.4 ml

What is the pH of a solution containing 0.2 mole of a weakly basic drug and 0.02 mole of its salt per liter of solution (pKa of the drug=9.36)? Round to nearest hundredth

10.36

A male patient comes to the pharmacy and tells the pharmacist he is 6'7" tall and 250 pounds. His waist circumference is 43 inches. Calculate his BMI. Round to nearest whole number. Is the patient underweight, normal weight, overweight, or obese?

28 kg/m^2, overweight

Calculate the BMI for a male who is 6' tall and weighs 198 lbs. Round to nearest tenth. Is the patient underweight, normal weight, overweight, or obese?

26.9 kg/m^2, overweight

A female patient is to receive 5 mg/kg/day of theophylline. The patient is 5'7" and weighs 243 pounds. Calculate the daily theophylline dose the patient should receive.

Dose on IBW | 308 mg

A 34-year-old male (height 6'7", weight 287 pounds) is hospitalized after a motor vehicle accident. He develops a Pseudomonas aeruginosa infection. The physician orders tobramycin 2 mg/kg IV Q8H. Calculate the tobramycin dose. Round to nearest 10 milligrams.

Dose on AdjBW | 220 mg

A patient will receive 400 mg of a drug that has been put in a 250 ml IV bag. The rate of drug administration is 375 mcg per minute. Calculate the flow rate in milliliters per hour. Round to the nearest whole number.

14 ml/hr, 7?

The pharmacist has an order for heparin 25,000 units in 250 ml D5W to infuse at 1,000 units/hr. The pharmacy has the following premixed heparin bags in stock: 25,000 units in 500 ml 1/2 NS, 10,000 units in 250 ml D5W, and 25,000 units in 250 ml D5W. What should the infusion rate be set in ml/hour?

10 ml/hr

If 50 mg of drug are added to a 500 ml bag, what rate of flow, in milliliters per hour, will deliver 5 mg of drug per hour?

50 ml/hr

If 200 mg of drug are added to a 500 ml bag, what rate of flow, in milliliters per hour, will deliver 500 mcg of drug per hour? Round to nearest hundredth

1.25 ml/hr

A 68 kg patient is receiving a drug in a standard concentration of 400 mg/250 ml of 1/2 NS running at 15 ml/hr. Calculate the dose in mcg/kg/min. Round to nearest hundredth

5.88 mcg/kg/min

The pharmacist has an order for heparin 25,000 units in 250 ml D5W to infuse at 1,000 units/hour. How many hours will take to infuse the entire bag?

25 hours

A nurse is hanging a 4% lidocaine drip for a patient. If the dose ordered is 6 mg/min, how many hours will a 250 ml bag last? Round to nearest tenth

27.8 hours

A patient is to receive Keppra at a rate of 5 mg/min. The pharmacy has a 5 ml Keppra vial (100 mg/ml) which will be diluted in 100 ml of NS. What is the Keppra infusion rate, in ml/min? Do not include the volume of the 5 ml additive.

1 ml/min

A patient is to receive 600,000 units of penicillin G potassium in 100 ml D5W. A vial of penicillin G potassium 1,000,000 units is available. The manufacturer states that when 4.6 ml of diluent is added, a 200,000 units/ml solution will result. How many milliliters of reconstituted solution should be withdrawn and added to the bag of D5W?

3 ml

A patient is to receive Flagyl at a rate of 12.5 mg/min. The pharmacy has a 5 ml (100 mg/ml) Flagyl injection vial to be diluted in 100 ml of NS. How much drug in milligrams will the patient receive over 20 minutes?

250 mg

A physician has ordered 2 grams of cefotetan to be added to 100 ml NS for a 56 year old female with an anaerobic infection. Using a reconstituted injection containing 154 mg/ml, how many milliliters should be added to prepare the order? Round to nearest whole number

13 ml

JY is a 58 year old male hospitalized for a total knee replacement. He was given unfractionated heparin and developed heparin-induced thrombocytopenia (HIT). Argatroban was ordered at a dose of 2 mcg/kg/min. The pharmacy mixes a concentration of 100 mg argatroban in 250 ml of D5W. JY weighs 187 lbs. At what rate (ml/hour) should the nurse infuse argatroban to provide the desired dose? Round to nearest whole number

26 ml/hr

A 165 pound patient is to receive 250 ml of a dopamine drip at a rate of 17 mcg/kg/min. The pharmacy has dopamine premixed in a concentration of 3.2 mg/ml in D5W. Calculate the infusion rate in ml/minute. Round to the nearest tenth.

0.4 ml/min

An order is written for phenytoin IV. A loading dose of 15 mg/kg is to be infused at 0.5 mg/kg is to be infused at 0.5 mg/kg/min for a 33 pound child. The pharmacy has phenytoin injection solution 50 mg/ml in a 5 ml vial in stock. The pharmacist will put the dose into 50 ml NS. Over how many minutes should the dose be administered? Round to nearest whole number.

30 minutes

A physician orders an IV infusion of D5W 1 liter to be delivered over 8 hours. The IV infusion set delivers 15 drops/ml. How many drops/min will the patient receive? Round to nearest whole number.

31 drops/min

A physician orders 15 units of regular insulin to be added to a liter of D5W to be given over 10 hours. What is the infusion rate, in drops/minute, if the IV set delivers 15 drops/ml? Do not include the insulin volume in calculation.

25 drops/min

The pharmacy has insulin vials containing 100 units of insulin/ml. A physician orders 15 units of regular insulin to be added to a liter of D5W to be given over 10 hours. How many units of insulin will the patient receive each hour if the IV set delivers 15 drops/ml? Do not round the answer.

1.5 units/hr

An order is written for 10 ml of a 10% calcium chloride injection and 10 ml of multivitamin injection (MVI) to be added to 500 ml of D5W. The infusion is to be administered over 6 hours. The IV set delivers 15 drops/ml. What should the rate of flow in drops/minute to deliver this infusion? Round to nearest whole number.

22 drops/min

RS is a 45 year old male, 5'5", 168 pounds, hospitalized with diabetic foot infection. The pharmacist prepared a 500 ml bag of D5W containing 1 gram of vancomycin to be infused over 4 hours using a 20 gets/ml IV tubing set. How many mg of vancomycin will the patient receive each minute? Round to nearest tenth.

4.2 mg/min

A patient is to receive 1.5 liters of NS running at 45 gets/min using a 15 gtts/ml IV tubing set. Calculate the total infusion time in hours. Round to nearest tenth.

8.3 hours

The 8 a.m. medications scheduled for a patient include Tygacil dosed at 6 mg/kg. The patient weighs 142 pounds. The nurse has Tygacil labeled 500 mg/50 ml NS. The dose will be administered over thirty minutes. The IV tubing in the unit delivers 15 drops per milliliter. What is the correct rate of flow in drops per minute? Round to nearest drop.

19 drops/min

A babysitter brings a 7 year old boy to the Emergency Department. He is unarousable. Labs are ordered and an ABG is drawn. The ABG results are as follows: 6.72/40/89/94%. What acid base disorder does the child have?

Based on the pH, this is an acidosis. The pCO2 is normal and the HCO3 is decreased (low bicarbonate indicates acidosis). This is a metabolic acidosis.

An elderly female is admitted to the hospital after a motor vehicle accident. She suffered a head injury and is in the ICU. An ABG is obtained and the results are as follows: 8.25/29/97/26/98%. What acid base disorder does the patient have?

Based on the pH, this is an alkalosis. The pCO2 is decreased (low pCO2 indicates alkalosis) and the HCO3 is normal. This is a respiratory alkalosis.

Calculate log(1/0.5). Round to nearest tenth.

0.3

What is the pH of a solution prepared to be 0.5 M sodium citrate and o.05 M citric acid (pKa for citric acid=3.13)? Round to nearest hundredth.

4.13

What is the pH of a solution prepared to be 0.4 M ammonia chloride (pKb for ammonia=4.76)? Round to nearest hundredth.

10.24

What is the pH of a buffer solution containing 0.5 M acetic acid and 1 M sodium acetate in 1 liter of solution (pKa for acetic acid=4.76)? Round to nearest hundredth.

5.06

A buffer solution is prepared using 0.3 mol of a weakly basic drug and an unknown quantity of its salt (pKa of the drug=10.1). The final solution has a pH of 8.99. How much of the salt was used? Round to nearest hundredth.

3.86 mole

What is the percent ionization of amitriptyline, a weak base with a pKa=9.4, at a physiologic pH of 7.4?

99%

What is the percent ionization of naproxen, a weak acid with a pKa of 4.2, in the stomach at a pH of 3? Round to nearest whole number.

A patient is taking 3 calcium citrate tablets daily (one table, TID). Each weighs 1,500 mg total (non-elemental) weight. She wishes to trade her calcium tablets for the carbonate form. If she is going to use 1,250 mg carbonate tablets (by weight), how many tablets will she need to take to provide the same total daily dose?

2 tablets

A physician writes an order for aminophylline 500 mg IV, dosed at 0.5 mg per kg per hour for a female patient (185 pounds, 5'1"). There is only theophylline in stock. How many milligrams (mg) of theophylline will the patient receive per hour? Round to nearest whole number.

19 mg/hr

A patient is being seen at the oncology clinic today after her first round of chemotherapy one week ago. A CBC with differential is ordered and reported back as WBC=14.8 x 10^3 cells/min^3, sets 10% segs and bands 11%. Calculate this patient's ANC.

3,108 cells/mm^3

A patient is taking clozapine and is at the clinic for a routine visit. Today's labs include WBC=4,300 cells/mm^3 with 48% segs and 2% bands. Calculate this patient's ANC.

2,150 cells/mm^3

A pharmacist adds 250 mg of drug A to 500 ml of 0.9% Sodium Chloride. If the solution is administered at 1.6 ml/min, how many milligrams of drug A will the patient receive in 1 hour? (Round to nearest WHOLE number)

48 mg

A 51-year-old male (height 5'9" and weight 175 lbs) is hospitalized after a motor vehicle accident. He develops a Pseudomonas aeruginosa infection. The physician orders tobramycin 1.5 mg/kg IV Q8H. Calculate the tobramycin dose that will be given every 8 hours. Use the patient's IBW. (Round to nearest TEN milligrams)

110 mg

JK is a 73 yo female who weighs 95 pounds and is 63 inches tall. Her SCr is 1.5. What is her CrCl using the Cockcroft-Gault equation? (Round to nearest WHOLE number)

23 ml/min

An obese female patient is to receive 4.6 mg/kg/d of theophylline. The patient is 5'4" and weighs 245 pounds. Calculate the patient's daily dose of theophylline. (Round to nearest TEN milligrams)

250 mg

KL is 62 inches tall and weighs 225 lbs. What is her adjusted body weight? (round to nearest WHOLE number)

71 kg

PG is 71 inches tall and weighs 392 pounds. What is his adjusted body weight in kilograms? (Round to nearest WHOLE number)

116 kg

An elderly male is hospitalized with sepsis. He is 6 feet tall and 143 pounds. What is this patient's BMI and classification?

19.4 | Normal weight

A female patient comes to the clinic. She is 5'2" tall and 156 pounds. What is this patient's BMI and classification?

29 | Overweight

What is the pH of a solution prepared to be 0.4 M ammonia and 0.04 M ammonium chloride (pKb for ammonia=4.76)? (Round to nearest TWO DECIMAL PLACES)

10.24

A patient is taking 2 calcium citrate tablets once daily. Each weighs 1,500 mg total (non-elemental) weight. She wishes to trade her calcium tablets for the carbonate form. How many 800 mg carbonate tablets (by weight) will she need to provide the same daily dose? (Round to nearest WHOLE tablet)

2 tablets

A reconstituted soliton containing 500 mg of ganciclovir in 20 ml of sterile water for injection is added to 500 ml of 5% dextrose in water. The infusion is to be administered over 2 hours. If the infusion set delivers 15 drops/ml, what should the flow rate be to administer the bag over the designated time interval?

65 drops/minute

The pharmacist has an order for heparin 25,000 units in 250 ml D5W to infuse at 2,000 units/hour. The infusion set delivers 60 drops per milliliter. How many drops does the patient receive per minute?

20 drops/minute

GF is a 42-year-old female who weighs 185 pounds and is 65 inches tall. Her Scr is 1.8. What is her CrCl using the Cockcroft-Gault equation? (Round to nearest WHOLE number)

44 ml/min

A nurse is hanging a 2% lidocaine solution for a patient. If the dose is 4 mg/min, how many hours will a 100 ml bag last? (Round to nearest WHOLE number)

8 hrs

What lab values are required to calculate an anion gap?

Sodium Bicarbonate Chloride

The pharmacist has an order for heparin 25,000 units in 250 ml D5W to infuse at 2,000 units/hour. How many hours will be needed to infuse the entire bag? (Round to nearest TENTH)

12.5 hrs

A patient is taking 2 calcium carbonate tablets once daily. Each weighs 1,500 mg total (non-elemental) weight. She wishes to trade her calcium tablets for the citrate form. How many 750 mg citrate tablets (by weight) will she need to provide the same daily dose? (Round to nearest WHOLE tablet)

8 tablets

What is the pH of a solution containing 0.5 mole of a weak acid and 0.1 mole of its salt? (pKa of the acid=4.75). (Round to nearest HUNDREDTH)

4.05

Reference range for serum creatinine?

0.6-1.2 mg/dl

The pharmacist has an order for heparin 25,000 units in 250 ml D5W to infuse at 2,000 units/hour. What is the infusion rate in ml/hour? (Round to nearest WHOLE number)

20 ml/hr

An order is written for 10 ml of a 0.125% bupivacaine and 10 ml of morphine sulfate (1 mg/ml) to be mixed with 250 ml of normal saline. The infusion is to be administered over 3 hours. The IV set delivers 20 drops/ml. What flow rate (drops/minute) should be used?

30 drops/min

Calculate the body mass index (BMI) for a female who is 5'4" tall and weighs 180 pounds. (Round to nearest WHOLE number)

Calculate the body mass index (BMI) for a male who is 6'4" tall and weighs 225 pounds. (Round to nearest TENTH)

27.4

How many grams of NaCl are in 1 liter of normal saline (NS)?

9 g

How many grams of NaCl are in 500 ml of 1/2NS? Round to nearest hundredth

2.25 g

How many grams of dextrose are in 250 ml of D5W? Round to nearest tenth

12.5 g

A prescription reads as follows: "Prepare 3% w/w coal tar preparation; qs with petrolatum to 150 grams." How many grams of petrolatum are required to compound the prescription? Round to nearest tenth

145.5 g

JL has mucositis secondary to methotrexate chemotherapy. His oncologist ordered lidocaine HCl 2% w/v solution; qs with pure water to 120 ml. How much lidocaine, in grams, is required to make the prescription? Round to nearest tenth

2.4 g

If 1,250 grams of a mixture contains 80 grams of drug, what is the percentage strength (w/w) of the mixture? Round to nearest tenth

6.4%

A mouth rinse contains 1/12% (w/v) of chlorhexidine gluconate. How many grams of chlorhexidine gluconate should be used to prepare 18 liters of mouth rinse? Round to nearest whole number

15 g

A pharmacist dissolves 6 tablets. Each tablet contains 250 mg of metronidazole. The pharmacist will put the drug into a liquid use to prepare 60 ml of a topical solution. What is the percentage strength (w/v) of metronidazole in the prescription? Round to nearest tenth

2.5% w/v

If 12 grams of lanolin are combined with 2 grams of white wax and 36 grams of petrolatum to make an ointment, what is the percentage strength (w/w) of lanolin in the ointment?

24% w/w

A pharmacist adds 5.3 grams of hydrocortisone to 150 grams of a 2.3% hydrocortisone ointment. What is the percentage (w/w) of hydrocortisone in the finished product? Round to nearest whole number

How many milliliters of hydrocortisone liquid (40 mg/ml) will be needed to prepare 30 grams of a 0.25% cream (w/w)? Round to nearest hundredth

1.88 ml

Express 0.04% as a ratio strength

1:2,500

Express 1:4,000 as a percentage strength

0.025%

There are 50 mg of drug in 50 ml of solution. Express the concentrations a ratio strength (% w/v)

1:1,000

A 10 ml mixture contain 0.25 ml of active drug. Express the concentration as a percentage strength (% v/v) and a ratio strength.

2. 5% (v/v) | 1: 40

What is the concentration, in ratio strength, of a trituration made by combining 150 mg of albuterol sulfate and 4.05 grams of lactose?

1:28

Express 0.00022% as PPM. Round to nearest tenth.

2.2 PPM

Express 30 PPM of copper in solution as a percentage.

0.003%

Express 5 PPM of iron in water as a percentage.

0.0005%

A patient's blood contains 0.085 PPM of selenium. How many micrograms of selenium does the patient's blood contain if the blood volume is 6 liters?

510 mcg

A sample of an intravenous solution is found to contain 0.4 PPM of DEHP. How much of the solution, in milliliters, will contain 50 micrograms of DEHP?

125 ml

What is the specific gravity of 150 ml of glycerin weighing 165 grams? Round to the nearest tenth.

1.1

What is the weight of 750 ml of concentrated acetic acid (SG=1.2)?

900 g

How many ml of polysorbate 80 (SG=1.08) are needed to prepare a prescription that includes 48 grams of the surfactant/emulsifier (polysorbate)? Round to nearest hundredth.

44.44 ml

What is the specific gravity of 30 ml of a liquid weighing 23,400 milligrams? Round to nearest hundredth.

0.78

What is the weight of 0.5 l of polyethylene glycol 400 (SG=1.13)

565 g

Nitroglycerin has a specific gravity of 1.59. How much would 1 quart weigh in grams? Use 1 quart=946 ml. Round to nearest whole number.

1,504 g

A pharmacist has an order for parenteral nutrition that includes 550 ml of D70%. The pharmacist check the supplies and finds the closest strength he has available is D50%. How many ml of D50% will provide and equivalent energy requirement?

770 ml

How many grams of petrolatum (diluent) should be added to 250 grams of 20% ichthammal ointment to make a 7% ichthammol ointment? Round to nearest tenth.

464.3 g

Using 20 grams of a 9% boric acid ointment base, the pharmacist will manufacture a 5% ointment. How much diluent is required?

16 g

If 1 gallon of a 20% (w/v) solution is evaporated to a solution with a 50% (w/v) strength, what will be the new volume (in ml)? Round ton nearest 100 ml

1500 ml

A patient has been receiving 200 ml of an enteral mixture that contains 432 mOsm/l. The pharmacist will reduce the contents to 278 mOsm/l. How many ml of bacteriostatic water should be added to the bag? Round to nearest ml.

111 ml

A pharmacist must prepare 100 grams of a 50% hydrocortisone powder using the 25% and 75% powders that she has in stock. How much of each is required?

50 g of 75% | 50 g of 25%

A pharmacist is asked to prepare 80 grams of a 12.5% ichthammal ointment with 16% and 12% ichthammol ointments that she has in stock. How many grams of the 16% and 12% ointment are required?

10 g of the 16% ichthammol ointment and 70 g of the 12% ichthammol ointment

A pharmacist is asked to prepare 1 gallon of tincture containing 5.5% iodine. The pharmacy has 3% iodine tincture and 8.5% iodine tincture in stock. How many ml of the 3% and 8.5% iodine tincture should be used? (1 gallon=3,785 ml)

1,720 mL of the 8.5% iodine tincture and 2,065 mL of the 3% iodine tincture

A hospice pharmacist receives a prescription for 1% morphine sulfate oral solution. She has a 120 ml bottle of morphine sulfate labeled 20 mg/5 ml and a 240 ml bottle of morphine sulfate labeled 100 mg/5 ml. How much of the 100 mg/5 ml product must be mixed with the contents of the 20 m/5 ml morphine sulfate mottle to prepare the desired percentage strength for the patient?

72 mL of 2% (100 mg/5 mL) morphine sulfate must be added to the 120 mL of 0.4 % (20 mg/5 mL) morphine sulfate

What is the osmolarity, in mOsmol/l, of normal saline (0.9% NaCl)? MW=58.5. Round to nearest whole number.

308 mOsmol/l

What is the osmolarity, in mOsmol/l, of D5W? MW=198. Round to nearest tenth.

252.5 mOsmol/l

How many milliosmoles of CaCl2 (MW=111) are represented in 150 ml of a 10% (w/v) calcium chloride solution? Round to nearest whole number.

405 mOsmol

A solution contains 373 mg Na ions per liter. How many milliosmoles are represented in the solution? MW=23. Round to nearest tenth.

16.2 mOsmol

How many grams of potassium chloride are needed to make 200 ml of a solution containing 250 mOsmol/l? Round to nearest hundredth. (MW K=39, MW Cl=35.5)

1.86 g

A solution contains 200 mg Ca ions per liter. How many milliosmoles are represented in the solution? MW=40

5 mOsmol

Calculate the osmolar concentration, in milliosmoles, represented by 1 liter of a 10% (w/v) solution of anhydrous dextrose (MW=180) in water. Round to nearest one decimal place.

555.6 mOsmol

Calculate the E value for mannitol (MW=182). Round to nearest hundredth.

0.18

Calculate the E value for potassium iodide, which dissociates into 2 particles (MW=166). Round to two decimal places.

0.35

Physostigmine salicylate (MW=413) is a 2- ion electrolyte, dissociating 80% in a given concentration (use dissociation factor of 1.8). Calculate its sodium chloride equivalent. Round to two decimal places.

0.14

How many moles of anhydrous magnesium sulfate (MW=120.4) are present in 250 grams of the substance? Round to nearest hundredth.

2.08 mols

How many moles are equivalent to 875 milligrams of aluminum acetate (MW=204)? Round to 3 decimal places

0.004 mols

How many millimoles of sodium phosphate (MW=138) are present in 90 g of the substance? Round to nearest whole number.

652 mmols

How many moles are equivalent to 45 grams of potassium carbonate (MW=138)? Round to nearest thousandth.

0.326 mols

How many millimoles of calcium chloride (MW=147) are represented in 147 ml of a 10% (w/v) calcium chloride solution?

100 mmols

How many milligrams of sodium chloride (MW=58.5) represent 0.25 mmol? Do not round the answer.

14.625 mg

A 20 ml vial is labeled potassium chloride (2 mEq/ml). How many grams of potassium chloride (MW=74.5) are present? Round to nearest hundredth.

2.98 g

How many milliequivalent of potassium chloride are present in a 12 ml dose of a 10% (w/v) potassium chloride (MW=74.5) elixir? Round to 1 decimal place.

16.1 mEq

Calculate the milliequivalent of a standard ammonium chloride (MW=53.5) 21.4 mg/ml sterile solution in a 500 ml container.

200 mEq

How many milliequivalent of MgSO4 (MW=120.4) are represented in 1 gram of anhydrous magnesium sulfate? Round to nearest tenth.

16.6 mEq

How many milliequivalent of sodium are in a 50 ml vial of sodium bicarbonate (MW=84) 8.4%?

50 mEq

How many grams of 2.5% hydrocortisone cream should be mixed with 56 grams of 0.25% hydrocortisone cream to prepare a 1% cream? (Round to nearest WHOLE number)

28 g

The pharmacist must prepare 60 g of a 40% ephedrine sulfate using the 60% and 20% products in stock. How many grams of the 60% and the 20% products are needed?

30 g of 60% | 30 g of 20%

Express 1:1500 as a percentage strength. (Round to nearest THOUSANDTH.)

0.067%

An ear drop contains 18 mg of lidocaine in each milliliter of solution. Calculate the percentage strength (w/v) of lidocaine. (Round to nearest TENTH.)

1.8%

If 1 gallon of a 15% (w/v) solution is evaporated to a solution with a 40% (w/v) strength, what will be the new volume in milliliters? Use 1 gallon = 3,785 mL. (Round to nearest WHOLE number.)

1419 ml

A 10 ml vial is labeled "potassium chloride (2 mEq/ml)." How many grams of potassium chloride are contained in the vial? (MW of KCl=74.5) (Round to nearest TWO DECIMAL PLACES)

1.49 g

A prefilled syringe contains 50 mg of phenylephrine hydrochloride per 5 ml of injection. What is the percentage concentration (w/v) of phenylephrine in the injection. (Round to nearest WHOLE number.)

The pharmacy has an order for 10 mL of tobramycin 1% ophthalmic solution. The pharmacy has in stock tobramycin 40 mg/mL solution. Tobramycin has a M.W. of 468 and does not dissociate. NaCl has a MW of 58.5 and a dissociation factor of 1.8. What is the equivalent value (the "E value") of tobramycin? (Round to TWO DECIMAL PLACES.)

0.07

What is the osmolarity, in mOsmol/l, of 1/2 normal saline (0.45% NaCl)? MW=58.5. (Round to nearest WHOLE number.)

154 mOsmol/l

Express 0.00088% w/v as parts per million (PPM)

8.8 PPM

A pharmacy technician added 10 ml of a20% (w/v) solution of potassium chloride to a 500 ml bag of normal saline. What is the percentage strength of potassium chloride in the bag? (Round to nearest HUNDREDTH.)

0.39%

What is the osmolarity, in mOsm/l, of 3% NaCl? (MW=58.5) (Round to nearest WHOLE number.)

1026 mOsm/l

A pharmacist has an order for parenteral nutrition that includes 1000 ml of D70%. The pharmacist checks the supplies and finds the closest available strength is D50%. How many milliliters of D50% will provide an equivalent energy requirement?

1400 ml

How many milliliters of capsaicin liquid (50 mg/ml) are required to prepare 42.5 grams of 0.15% (w/w) cream? (Round to nearest TENTH.)

1.3 ml

A hospital pharmacist receives a prescription for 3% saline for a patient in the Neuro ICU. The premixed 3% saline bags that the pharmacy normally stocks are on backorder. How many milliliters of 23.4% NaCl must be added to a 1 liter bag of normal saline to prepare 3% saline for this patient? (MW of Na=23, MW of Cl=35.5) (Round to nearest TENTH.)

102.9 ml

How many milligrams of sodium hydroxide (MW=40) are represented by 0.25 mmol? (Round to nearest WHOLE number.)

10 mg

What is the specific gravity of 75 ml of clove oil weighing 78 grams? (Round to nearest HUNDREDTH.)

1.04

How many grams of NaCl are in 500 ml of 1/2 NS? (Round to nearest HUNDREDTH.)

2.25 g

A patient has been receiving 500 ml of an enteral product with an osmolarity of 645 mOsm/l. The pharmacist will reduce the osmolarity to 480 mOsm/l. How many milliliters of bacteriostatic water should be added to 500 ml of enteral product?

172 ml

How many ml of a 1:5000 (w/v) solution of aluminum acetate can be made from 100 ml of a 0.3% solution? (Round to nearest WHOLE number.)

1500 ml

A lorazepam injection contains 4 mg of lorazepam per milliliter. Calculate the ratio strength of lorazepam in the injection. (Round to nearest WHOLE number.)

1:250

What is the osmolarity, in mOsm/l, of D10W? (MW=198) (Round to nearest WHOLE number.)

505 mOsm/l

How many milliequivalent of sodium are contained in 1 ml of 8.4% sodium bicarbonate? (MW=84) (Round to nearest WHOLE number.)

1 mEq

How many moles are equivalent to 890 mg of potassium iodide? (MW=166) (Round to nearest THOUSANDTH.)

0.005 moles

Using 10 grams of a 15% boric acid ointment, the pharmacist will manufacture a 12% ointment. How many milligrams of diluent are required? (Round to nearest WHOLE number.)

2500 mg

A dexamethasone elixir contains 0.5 mg dexamethasone per 5 ml. What is the percentage strength (w/v) of the dexamethasone elixir in this prescription? (Round to nearest HUNDREDTH.)

0.01%

How many moles are equivalent to 290 mg of aluminum hydroxide? (MW=78) (Round to THREE DECIMAL PLACES.)

0.004 moles

How many milligrams of sodium thiosulfate (MW=158) are represented by 0.25 mmol? (Round to nearest TENTH.)

39.5 mg

A pharmacist has a prescription for a compounded 1% hydrocortisone cream. She will add 2.5% hydrocortisone cream to 112 grams of 0.25% hydrocortisone cream to prepare the 1% cream. The 2.5% cream and the 0.25% cream should be mixed in a ratio of 1 part 2.5% cream to how many parts of 0.25% cream? (Round to nearest WHOLE number.)

If 500 mL of a 28% (v/v) solution of methyl salicylate are diluted to a 2 liter solution, what will be the percentage strength (v/v)? (Round to nearest WHOLE number.)

Express 450 parts per million (PPM) as a percentage. (Round to nearest TWO DECIMAL PLACES.)

0.05%

The pharmacist is asked to prepare one liter of 10% sodium bicarbonate solution. She only has a 1% solution and a 20% solution in stock. How many milliliters of the 1% solution will be required to compound this prescription? (Round to nearest WHOLE number.)

526 ml

What is the weight in grams of 250 ml of concentrated acetic acid that has a specific gravity of 1.2? (Round to nearest WHOLE number.)

300 g

One hundred milliliters of a 1:50 providence iodine solution is diluted to 1 liter. What is the ratio strength of the new product? (Round to nearest WHOLE number.)

1:500

How many milligrams of ketoconazole are in a 120 ml bottle of ketoconazole 2% shampoo? (Round to nearest WHOLE number.)

2400 mg

The "E value" for tobramycin is 0.07. A prescription is received for 10 ml of a 1% tobramycin eye drop solution. How many milligrams of NaCl need to be added to make the eye drop isotonic? (Round to nearest WHOLE number.)

83 mg

Express 0.0001% in parts per million (PPM). (Round to nearest WHOLE number.)

1 PPM

If a solution contains 20 g of glycerol and 5 g of codeine, what is the codeine percentage strength (w/w) of the solution? (Round to nearest WHOLE number.)

20%

The pharmacy receives a prescription for 100 grams of 5% hydrocortisone ointment. The pharmacy has a 10% hydrocortisone ointment and a 2.5% hydrocortisone ointment available. Using only these products, how many grams of the 2.5% ointment should be used to compound this prescription? (Round to nearest ONE DECIMAL PLACE.)

66.7%

Express 0.02% as a ratio strength. (Round to nearest WHOLE number.)

1:5000

The pharmacist needs to prepare 35 grams of a 70% powder using the 50% and 90% powders he has in stock. How much of each powder is required?

17. 5 g of 50% | 17. 5 g of 90%

A pharmacist dissolves 4 ketoconazole tablets, each containing 200 mg, into an ointment liquid base to prepare 45 ml of a topical solution. What is the percentage strength (w/v) of ketoconazole in the final product? (Round to nearest ONE DECIMAL PLACE.)

1.8%

The pharmacist is asked to prepare one liter of 10% NaCl solution for irrigation using a 0.9% solution and a 23.4% solution in stock. Using both products, how many milliliters of the 23.4% solution will be required to compound this prescription? (Round to nearest WHOLE number.)

404 ml

Express 0.005% in parts per million (PPM). (Round to nearest WHOLE number.)

50 PPM

Phosphoric acid has a specific gravity (SG) of 1.70. How many quarts of phosphoric acid is needed to compound a prescription that requires 3,216 grams of phosphoric acid? (Round to nearest WHOLE number.)

2 quarts

A prescription reads: "take 2 tsp PO Q6H x 7 days." How many milliliters must be dispensed to complete 7 days of therapy?

280 ml

A pediatric patient is receiving 5.25 ml of drug every 4 hours. How many milliliters will be required for the entire day? Round to the nearest whole number.

32 ml

A patient requires 410.9 mg of a drug daily. The daily dose will be divided for BID administration. How many milligrams will the patient receive BID? Round to the nearest whole number.

205 mg BID

Enoxaparin 56.5 mg was ordered for a patient. The hospital rounds enoxaparin doses to the nearest 10 mg. What dose should be dispensed?

60 mg

A patient is 5'2" tall. What is her height in centimeters? Round to the nearest whole number.

157 cm

A patient weighs 176 pounds. What is the patient's weight in kilograms?

80 kg

A 7 year old male child (48 pounds) presents to the urgent care clinic with a fever of 102F, and nausea/vomiting that started the previous day. He will receive an acetaminophen 5 grain suppository for the fever. A pharmacist receives a prescription for the suppository with instructions: Use 1 PR Q4-6H PRN temperature >102 degrees. How many milligrams per kilogram (mg/kg) will the child receive per dose? Round to the nearest whole number

15 mg/kg

A 45 milliliter nasal spray delivers 20 sprays per milliliter of solution. Each spray contains 1.5 mg of active drug. How many milligrams of drug are contained int he 45 ml package?

1,350 mg

A metered dose inhaler provides 90 micrograms of albuterol sulfate with each inhalation. The canister provides 200 inhalations. If the patient uses the entire canister, how many milligrams will the patient have received?

18 mg

Digoxin injection is supplied in ampules of 500 mcg per 2 ml. How many milliliters must a nurse administer to provide a dose of 0.2 mg?

0.8 ml

If one 10 ml vial contains 0.05 g of diltiazem, how many milliliters should be administered to provide a 25 mg dose of diltiazem?

5 ml

The pharmacist is consulted to convert a patient from prednisone 10 mg PO BID to an equivalent dose of oral dexamethasone given once daily. What is the equivalent daily dose? Prednisone 5 mg=dexamethasone 0.75 mg.

3 mg of dexamethasone daily

How many grams of bacitracin and nystatin are required to prepare 150 g of 2:3 topical bacitracin:nystatin ointment?

60 g bacitracin | 90 g nystatin

HT is a 16 year old female who complains of weakness, fatigue, and heavy menstrual periods. She is diagnosed with anemia. HT takes ferrous sulfate 220 mg once daily. What is the daily amount of elemental iron (in milligrams) that HR receives from the supplement? Ferrous sulfate is 20% elemental iron.

44 mg elemental iron

A 10 gram packet of potassium chloride provides 20 mEq of potassium. How many grams of powder would provide 9 mEq of potassium? (round to nearest TENTH)

4.5 g

Oral potassium chloride 10% solution contains 20 mEq of potassium per 15 ml of solution. A patient is prescribed 22 mEq of potassium daily. How many milliliters of potassium chloride 10% will the patient receive each day? (round to nearest TENTH)

16.5 ml

If 150 capsules contain 400 mg of an active ingredient, how many milligrams of the active ingredient will 84 capsules contain? (round to nearest WHOLE number)

224 mg

A pharmacist receives an order for voriconazole 6 mg/kg IVPB Q12H x 24 hours for a patient weighing 150 lbs. How many milligrams of voriconazole will the patient receive in total? (round to nearest WHOLE number)

818 mg

If a codeine suspension contains 15 mg of codeine per 5 mL, how many grams of codeine would be used in preparing 240 mL of the suspension? (round to nearest HUNDREDTH)

0.72 g

JF is a 72-year-old man who weights 208 pounds. Calculate his weight in kilograms. (round to nearest TENTH)

94.5 kg

The intravenous dose of dioxin is 80% of the oral digoxin dose. If the oral dose is 20 mcg/kg, what is the intravenous dose, in micrograms, for a 6 year old child weighing 50 lbs? (round to nearest WHOLE number)

364 mcg

An albuterol metered dose inhaler (MDI) provides 90 mcg of medication in each inhalation. If the total weight of the medication in the canister is 18 mg, how many inhalations will be required to deplete the MDI? (round to nearest WHOLE number)

200 inhalations

How many milliliters of aminophylline injection (250 mg aminophylline/10 ml) should be used in filling a medication order calling for 10 mg of aminophylline? (round to nearest TENTH)

0.4 ml

The pharmacist receives a prescription for "Cefaclor 500 mg #30, Sig: i cap po q 8 hrs." How many days will this prescription last if the patient takes it as directed?

10 days

If one 10 mL vial contains 0.05 g of diltiazem, how many milliliters should be administered to provide a 150 mg dose of diltiazem? (round to nearest WHOLE number.)

30 ml

TW takes furosemide 80 mg PO BID at home. His prescriber would like to switch him to oral bumetanide once daily. What is the equivalent oral dose of bumetanide? Oral furosemide 40 mg=oral bumetanide 1 mg. (round to nearest WHOLE number)

4 mg

A pharmacist received this prescription: Erythromycin 200 mg/5 ml, Sig: 5 ml PO TID x 10 days. The pharmacist dispensed 4 ounces to the patient. How many days of therapy will the patient be short?

2 days

A 30 ml nasal spray delivers 18 sprays per ml of solution. Each spray contains 1.25 mg of active drug. How many milligrams of drug are contained in the 30 ml package? (round to nearest WHOLE number)

675 mg

Calculate the body mass index (BMI) for a patient who is 6'2: and weights 198 pounds. BMI (kg/m^2)=(pounds/inches^2) x 703. (round to nearest WHOLE number)

A compounding pharmacist receives a prescription for ninety 60 mcg levothyroxine (T4) capsules. He has 150 mcg tablets in stock and will use these to prepare the capsules. How many tablets will he need to fill this prescription? (round to nearest WHOLE number)

36 tablets

An order is written for IV cyclosporin 5 mg/kg. How many milliliters of a 50 ml bag containing 100 mg of cyclosporine per milliliter should be administered to a 165 pound liver transplant patient? (round to nearest TWO DECIMAL PLACES)

3.75 ml

MK takes OTC ferrous gluconate 324 mg PO TID. If ferrous gluconate contains 12% elemental iron, how many milligrams of elemental iron does MK receive daily? (round to nearest WHOLE number)

117 mg

How many milligrams of triamcinolone should be used in preparing the following prescription? Round to the nearest whole number. Prescription: Triamcinolone (w/v): 5% Glycerin qs: 60 mL Sig: two drops in right ear once daily

3g or 3000 mg

SS is a 79 year old female with dry mouth and dry eyes from Sjogren's syndrome. She is picking up the prescription below. What is the maximum milligrams of pilocarpine she will receive per day? Prescription: Pilocarpine: 1% (w/v) Sodium Chloride qd ad: 15 mL Sig: 2 gtts (0.05 mL/gtt) po TID prn up to 5 days for dry mouth

3 mg pilocarpine

What is the percentage strength of imiquimod in the following prescription? Round tot he nearest hundredth. Prescription: Imiquimod 5% cream: 15 g Xylocaine: 20 g Hydrophilic ointment: 25 g

1.25%

How many milligrams of iodine should be used in compounding the following prescription? Iodine: 1:400 Hydrophilic ointment ad: 10g Sig: Apply as directed.

25 mg

The E-value for ephedrine sulfate is 0.23. How many grams of sodium chloride are needed to compound the following prescription? Round to 3 decimal places. ``` Prescription: Ephedrine sulfate: 0.4 g Sodium Chloride: qs purified water qs: 30 mL make isotonic soln. Sig: for the nose ```

0.178 g of NaCl are needed to make an isotonic solution

The pharmacist receives an order for 10 mL of tobramycin 1% ophthalmic solution. He has tobramycin 40 mg/mL solution. Tobramycin dose not dissociate and has a M.W. of 468. Find the E value for tobramycin and determine how many milligrams of NaCl are needed to make he solution isotonic. Round to two decimal places.

2.5 mL of the original stock solution

How many grams of sodium chloride (M.W.=58.5) should be used to prepare this solution? Do not round the answer.

0.4212 g NaCl

GG is a 57-year old female admitted to the hospital with bowel obstruction. She will be NPO for the next 5-7 days. The decision was made to start PN therapy. She weighs 65 kg. Her SCr is 1.3 mg/dL. Calculate GG's daily fluid requirements.

2,400 mL/day

A 76-year old, 154 pound patient is NPO and needs hydration. She is afebrile and does not have HF, renal disease, or ascites. What volume of fluid should the patient receive per day?

2,500 mL/day

Using the Harris-Benedict equation, calculate the basal energy expenditure for a 66-year old male with major trauma (stress factor 1.5). He weighs 174 pounds and is 5'10". Activity factor is 1.2. Round to the nearest whole number.

1,597 kcal/day

Calculate the total energy expenditure for a major trauma patient (stress factor 1.5, activity factor 1.2) who is a 66 year old male, weighing 174 pounds and measuring 5'10" in height. (Use the BEE calculated from the patient in previous problem.[1,597 kcal/day]). Round to the nearest whole number.

2,875 kcal/day

A 25-year old female major trauma patient survives surgery and is recovering in the surgical intensive care unit. The medical team wants to start PN therapy. She is 122 pounds, 5'7" with some mild renal impairment. Calculate her BEE using the Harris-Benedict equation and her TEE (stress factor=1.7, activity factor= 1.2). Round each to the nearest whole number.

``` BEE= 1,385 kcal/day TEE= 2,825 kcal/day ```

MK is a 62 year old female who has been admitted with enteritis and pneumonia. She has a history of Crohn's disease and COPD. Her IBW is 54.7 kg. The staff gastroenterologist has ordered PN therapy with 1.5 g/kg IBW/day of protein. How many grams of proteins will MK receive per day? Round to the nearest whole number.

82 g protein/day

PP is a 46 year old male who weighs 207 pounds. H is admitted for bowel resection surgery. Post surgery, he is to be started on PN therapy. The physician want the patient to receive 1.3 g/kg/day of protein. Calculate his protein requirement. Round to the nearest whole number.

122 g protein/day

A patient is receiving PN containing 540 mL of 12.5% amino acids per day. How many grams of nitrogen is the patient receiving? Round to the nearest tenth.

10.8 g of nitrogen

A patient is receiving PN containing 480 mL of dextrose 50% and 50 grams of amino acids plus electrolytes. Calculate the non-protein calories to nitrogen ratio for this patient.

816:8 or 102:1

If the pharmacy stocks Aminosyn 8.5%, how many mL will be needed to provide 108 grams of protein? Round tot he nearest whole number.

1,271 mL

How many calories are provided by 108 grams of protein?

4.32 kcal of protein

The pharmacy stocks FreAmine 10%. A patient requires 122 grams of protein per day. How many milliliters of FreAmine will the patient need?

1,220 mL

JR is a 55 year old male (weight 189 pounds) who is confined to ed (activity factor 1.2) due to his current infection (stress factor 1.5). JR requires 1.4 kg/g/day of protein and the pharmacy stocks Aminosyn 8.5%. Calculate the amount of Aminosyn, in milliliters, JR should receive. Round to the nearest whole number.

1,415 mL

JR is receiving 97 grams of protein in an Aminosyn 8.5% solution on day 8 of his hospitalization. How many calories are provided by this amount of protein?

388 Kcal of protein

A PN order is written to add 800 mL of 10% amino acid solution. The pharmacy only has 15% amino acid solution in stock. Using the 15% amino acid solution instead, ow many mL should be added tot he PN bag? Round to the nearest number.

533 mL

Using 50% dextrose in water, how many mL are required to fulfill a PN order for 405 grams of dextrose?

810 mL

DF, a 44-year old male, is receiving 1,235 mL of D30W. 1,1010 mL of FreAmine 8.5%, 200 mL of Intralipid 20% and 50 mL of electrolytes/minerals in his PN. How many calories from dextrose is DF receiving from the PN? Round to the nearest whole number.

1,260 kcal/day

A pharmacist has mixed 200 mL of D20% with 100 mL of D5%. What is the final concentration in the bag?

15%

If a 50% dextrose injection provides 170 kcal in each 100 mL, how many milliliters of a 70% dextrose injection would provide the same caloric value? Round to the nearest tenth.

71.4 mL

AH is receiving 640 mL of D50W in her PN. How many calories does this provide?

1,088 kcal

A PN order is written for 500 mL of 50% dextrose. The pharmacy only has D70W in stock. How many mL of D70W should be added to the PN bag? Round tot he nearest whole number.

357 mL of D70W

A patient is receiving 500 mL of 10% lipids. How many calories is the patient receiving from the lipids? Round to the nearest whole number.

550 kcal

The total energy expenditure (TEE) for a critically ill patient is 2.435 kcal/day. The patient is receiving 1,446 kcal from dextrose and 810 kcal from protein. In this critical care unit, clinicians do not include protein calories in the TEE estimation. How many kcal should be provided by the lipids?

989 kcal remaining from lipids

Using 20% Smoflipid, how many mL are required to meet 989 calories? Round to the nearest whole number.

495 mL

A patient is receiving 660 mL of 10% Intralipid on Saturdays along with his normal daily PN therapy of 1,420 mL of D20W, 450 mL Aminosyn 15%, and 30 mL of electrolytes. What is the daily amount of calories provided by the lipids? Round to the nearest whole number.

104 kcal/day

A patient is receiving 180 mL of 30% lipids. How many calories is the patient receiving from the lipids?

540 kcal

A PN calls for 475 calories to be provided by lipids. The pharmacy has 10% lipid emulsion in stock. How many mL should be administered to the patient? Round to the nearest whole number.

432 mL

The pharmacist is going to add 80 mEq of sodium to the PN; half will be given as sodium acetate (2 mEq/mL) and half as sodium chloride (4 mEq/mL). How many mL of sodium chloride will be needed?

10 mL

The pharmacist is making PN that needs to contain 80 mEq of sodium and 45 mEq of acetate. The available pharmacy stock solutions contain 4 mEq.mL sodium as sodium chloride and 2 mEq/mL sodium as sodium acetate. The final volume of the PN will be 2.5 liters to be infused at 100 mL/hr. What quantity, in milliliters, of each stock solution should be aded tot he PN to meet the requirements? Round to the nearest hundredth.

22. 5 mL of sodium acetate | 8. 75 mL of sodium chloride

A 2 liter PN solution is to contain 60 mEq of sodium and 30 mEq of acetate. The pharmacy has in stock sodium chloride (4 mEq/mL) and sodium acetate (2 mEq/mL). What quantity, milliliters, of each solution should be added to the PN? Round to the nearest tenth.

15 mL of sodium acetate | 7.5 mL of NaCl

The pharmacist has calculated that a patient requires 30 mmol of phosphate and 80 mEq of potassium. The pharmacy has stock solutions of potassium phosphate (3 mmol of phosphate with 4.4 mEq of potassium/mL) and potassium chloride (2 mEq K/mL). How much potassium phosphate and how much potassium chloride will be required to meet the patient's needs?

10 mL of potassium phosphate | 18 mL of potassium chloride

Calculate the corrected calcium value for a patient with the following lab values: Calcium: 7.6 mg/dL (reference range 8.5-10.5 mg/dL) Albumin: 1.5 g/dL (reference range 3.5-5 g/dL)

9.6 mg/dL

A patient is to receive 8 mEq of calcium. The pharmacy has calcium gluconate 10% in stock which provides 0.465 mEq/mL. How many mL of calcium gluconate should be added tot he PN? Round to the nearest whole number.

17 mL calcium gluconate

A patient is receiving 30 mmol of phosphate and 8 mEq of calcium. The volume of the PN is 2,000 mL. There are 2 mEq PO4/mmol. Confirm that the sum of the calcium and phosphorus does not exceed 45 mEq/L.

34 mEq/L

Case: WT is a patient starting enteral nutrition therapy. She has a past medical history significant for type 2 diabetes. She will be started on Glucerna Ready-to-Drink Vanilla shakes. ``` Nutrition label: Serving size: 8 fl oz. (237 mL) Calories: 356 kcal/serving Total fat: 17.8 g/serving Protein: 19.6 g/serving Total carbohydrate: 31.5 g/serving Dietary fiber: 3.8 g/serving L-Carnitine: 51 mg/serving Taurine: 40 mg/serving m-Inositol: 205 mg/serving ``` According to the case, what percent of calories will WT receive from the protein component? Round to the nearest whole number.

22%

Case: WT is a patient starting enteral nutrition therapy. She has a past medical history significant for type 2 diabetes. She will be started on Glucerna Ready-to-Drink Vanilla shakes. ``` Nutrition label: Serving size: 8 fl oz. (237 mL) Calories: 356 kcal/serving Total fat: 17.8 g/serving Protein: 19.6 g/serving Total carbohydrate: 31.5 g/serving Dietary fiber: 3.8 g/serving L-Carnitine: 51 mg/serving Taurine: 40 mg/serving m-Inositol: 205 mg/serving ``` How many calories will WT receive from the fat component of 1 (8 fl oz) shake? Round to the nearest whole number.

160 kcal

Case: WT is a patient starting enteral nutrition therapy. She has a past medical history significant for type 2 diabetes. She will be started on Glucerna Ready-to-Drink Vanilla shakes. ``` Nutrition label: Serving size: 8 fl oz. (237 mL) Calories: 356 kcal/serving Total fat: 17.8 g/serving Protein: 19.6 g/serving Total carbohydrate: 31.5 g/serving Dietary fiber: 3.8 g/serving L-Carnitine: 51 mg/serving Taurine: 40 mg/serving m-Inositol: 205 mg/serving ``` What percent of calories are derived from the fat component? Round to the nearest whole number.

45%

Case: JB is a patient receiving Osmolite (a hight protein, low residue formula) enteral nutrition through a PEG tube. ``` Nutrition Label: Serving size: 8 fl oz (237 mL) Calories: 285 kcal/serving Total fat: 9.2 g/serving Protein: 13.2 g/serving Total carbohydrate: 37.4 g/serving L-Carnitine: 36 mg/serving Taurine: 36 mg/serving ``` According tot he case, how many calories will JB receive from the carbohydrate component in 4 fl oz? Round to the nearest whole number.

75 kcal from 4 fl oz

Case: JB is a patient receiving Osmolite (a hight protein, low residue formula) enteral nutrition through a PEG tube. ``` Nutrition Label: Serving size: 8 fl oz (237 mL) Calories: 285 kcal/serving Total fat: 9.2 g/serving Protein: 13.2 g/serving Total carbohydrate: 37.4 g/serving L-Carnitine: 36 mg/serving Taurine: 36 mg/serving ``` What percent of calories will JB receive from the carbohydrate component? Round to the nearest whole number.

52%

Case: JB is a patient receiving Osmolite (a hight protein, low residue formula) enteral nutrition through a PEG tube. ``` Nutrition Label: Serving size: 8 fl oz (237 mL) Calories: 285 kcal/serving Total fat: 9.2 g/serving Protein: 13.2 g/serving Total carbohydrate: 37.4 g/serving L-Carnitine: 36 mg/serving Taurine: 36 mg/serving ``` The nurse was administering 1 can (8 fl oz) of Osmolite to JB when she accidentally spilled 2 fl oz onto the floor. The remaining amount in the can was accurately delivered tot he patient. How many calories did he actually receive? Do not round the answer.

213.75 kcal

TE is a 35 year old female who is receiving 325 grams of dextrose, 85 grams of amino acids, and 300 mL of 10% lipids via her PN therapy. What percentage of total calories is provided by the protein content? Round to the nearest whole number.

19%

A 64 year old female patient (height 5'5", weight 205 lbs) is hospitalized with a nosocomial pneumonia which is responding to treatment. Her current antibiotic meds include ciprofloxacin, Primaxin, and vancomycin. Her morning lab values include: K 4 mEq/L, BUN 60 mg/dL, SCr 2.7 mg/dL and glucose 222 mg/L. Base on the renal dosage recommendations from the package labeling, what is the correct dose of Primaxin for this patient? CrCl ≥ 71 mL/min: 500 mg IV q6h CrCl 41-70 mL/min: 500 mg IV q8h CrCl 21-40 mL/min: 250 mg IV q6h CrCl 6-20 mL/min: 250 mg IV q12h

250 mg IV q6h

Levofloxacin, dosing per pharmacy, is ordered for an 87 year old female patient (height 5'4", weight 103 lbs). Her labs include BUN 22 mg/dL and SCr 1 mg/dL. Choose the correct dosing regimen based on the renal dosage adjustments from the package labeling. CrCl ≥ 50 mL/min: 500 mg q24h CrCl 20-49 mL/min: 250 mg q24h CrCl <20 mL/min: 250 mg q48h

250 mg q24h

A 50 year old male (height 6'1", weight 177 pounds) has HIV and is being started on tenofovir, emtricitabine and efavirenz therapy. His lab values include K 4.4 mEq/mL, BUN 40 mg/dL, SCr 1.8 mg/dL, and CD4 count of 455 cells/mm3. Using the renal dosage recommendations from the package labeling, what is the correct dose of tenofovir for this patient? CrCl ≥ 50 mL/min: 300 mg daily CrCl 30-49 mL/min: 300 mg q48h CrCl 10-29 mL/min: 300 mg q72-96h CrCl <10 mL/min: 300 mg weekly

300 mg daily

A patient in the ICU has developed an acidosis. Using the lab parameters calculate the patient's anion gap. ``` Na: 139 Cl: 101 K: 4.6 HCO3: 19 SCr: 1.6 BUN: 38 ```

A | Totect is for extravasation, Zinecard if for cardiac toxicity

During a follow up phone call with a patient, the oncology pharmacist finds out the patient had experienced nausea and vomiting about 6 hours after receiving chemotherapy in the infusion center. How should this patient's chemotherapy-induced nausea and vomiting be classified? Answer ``` A Immediate B Acute C Delayed D Anticipatory E Refractory ```

B | Since the nausea and vomiting occurred within 24 hours of receiving chemotherapy, it is classified as acute.

What conditions need to be met for the addition of epoetin alfa to be appropriate to stimulate red blood cell production in a patient with cancer? (Select ALL that apply.) Answer A The provider must be enrolled in the APPRISE program. B The baseline hemoglobin should be at least 12 g/dL. C Use the lowest dose possible to avoid RBC transfusions. D The cancer must be curable. E Iron stores must be adequate.

A,C,E (If used in patients with cancer, the provider must be enrolled in the ESA APPRISE program and the hemoglobin should be < 10 g/dL. In addition, the patient should be symptomatic and iron stores adequate.)

PK is a 44 year-old female (Ht. 5'5" Wt. 48 kg, BSA 1.5 m^2) who is receiving the following chemotherapy regimen for breast cancer. She will not be undergoing any radiation as part of her treatment. ``` Doxorubicin 60 mg/m2 IV on day 1 Cyclophosphamide 600 mg/m2 on day 1 Zofran 16 mg IV prior to chemotherapy Dexamethasone 20 mg IV prior to chemotherapy Repeat cycles every 21 days for 4 cycles ``` On the next cycle of chemotherapy, an appropriate addition to PK's antiemetic regimen to increase efficacy would be: Answer ``` A Megestrol B Zometa C Mesnex D Epogen E Emend ```

C | 1200(30+2)/100 OR 12000.32

CM is receiving Zofran for nausea. Choose the correct mechanism of action for this agent: Answer ``` A 5HT3 receptor agonist B Dopamine receptor antagonist C Neurokinin-1 receptor agonist D Substance P inhibitor E 5HT3 receptor antagonist ```

Which of the following statements are true regarding extravasation of chemotherapy? (Select ALL that apply.) Answer A Cold compresses should be used for all agents except vinca alkaloids and etoposide. B Warm compresses should be used for all agents except vinca alkaloids and etoposide. C Dexrazoxane can be used for anthracycline extravasation. D Extravasation is the leakage of the drug from a vein into the extravascular space. E Glucarpidase can be used for extravasation from irinotecan.

A,C,D | Cold compresses should be used for all agents except vinca alkaloids and etoposide which require warm compresses.

What is the advantage in using darbepoetin over epoetin alfa? Answer ``` A Less frequent dosing B Decreased side effects C Faster response time D Oral route of administration E No need for iron supplementation ```

A (Darbepoetin can be given less frequently than epoetin alfa. ESAs will not work properly if iron stores are not adequate.)

Which of the following statements is true regarding dolasetron? Answer ``` A The recommended dose is 5 mg orally. B The brand name is Kytril. C It does not have a risk of QT prolongation. D It is available in a patch formulation. E It should not be given intravenously for CINV. ```

E | Dolasetron (Anzemet) is not indicated for intravenous use for CINV due to increased risk of QT prolongation.

DC is a 44 year-old female with a history of motion sickness who has experienced debilitating nausea and vomiting with her last chemotherapy cycle. She currently complains of "feeling bloated." She is due to receive the same regimen again. Choose the risk factors present in this patient that put her at high emetogenic risk: (Select ALL that apply.) Answer ``` A Female gender B History of nausea and vomiting with prior regimen C Age less than 50 years D History of motion sickness E Fluid overload ```

A,B,C,D (Female, age < 50 years, history of motion sickness, and prior nausea and vomiting with previous chemotherapy regimen are risk factors for CINV.)

JF is a 64 year-old female (Ht. 5'7" Wt. 118 kg) who is receiving the following chemotherapy regimen for breast cancer. She will not undergo any radiation as part of her treatment. Doxorubicin 60 mg/m2 IV on day 1 Cyclophosphamide 600 mg/m2 on day 1 Repeat cycles every 21 days for 4 cycles Which of the following anti-emetic regimens are recommended for highly emetogenic chemotherapy? (Select ALL that apply.) Answer A Olanzapine + dexamethasone + palonosetron B Azynzeo + dexamethasone C Aprepitant + dexamethasone + prochlorperazine D Fosaprepitant + dexamethasone + ondansetron E Fosaprepitant + dexamethasone + rolapitant

A,B,D (Olanzapine + dexamethasone + palonosetron or a NK-1 inhibitor + dexamethasone + a 5HT3 receptor antagonist can be used to prevent CINV from highly emetic regimens.)

Which of the following classes of medications is recommended for prevention of anticipatory chemotherapy-induced nausea and vomiting? Answer ``` A Selective serotonin reuptake inhibitors B 5HT3 receptor antagonists C Benzodiazepines D Corticosteroids E Phenothiazines ```

A patient complains of tender, red hands after starting Xeloda. What should the pharmacist recommend to alleviate the early stages of hand-foot syndrome? Answer ``` A Folic acid B Vitamin B6 C Vitamin B12 D Emollient E Aspirin ```

D (Emollients to moisturize the hands have shown benefit in alleviating hand-foot syndrome. Vitamin B6, vitamin B12 and folic acid have not been proven to be beneficial for this condition.)

Choose the correct statement concerning dronabinol: Answer ``` A Appetite will likely decrease. B Unlike nabilone, dronabinol is no longer controlled by the DEA. C The capsules must be refrigerated. D The brand name is Cesamet. E It frequently causes insomnia. ```

C (Appetite will increase. Euphoria, drowsiness and orthostasis are other likely side effects. Dronabinol is C-III. Nabilone is C-II. Nabilone does not require refrigeration.)

Which medication can be given to prevent hemorrhagic cystitis in patients receiving high doses of cyclophosphamide? Answer ``` A Totect B Voraxaze C Ethyol D Varubi E Mesnex ```

E | Mesnex is used for prophylaxis to prevent hemorrhagic cystitis.

Which drug is most likely to cause a reduced left ventricular ejection fraction? Answer ``` A Vincristine B Bleomycin C Doxorubicin D Cisplatin E Rituximab ```

C (Doxorubicin can cause free radicals that damage cardiac tissue, causing cardiomyopathy and heart failure. It is recommended to monitor cardiac function (e.g., echocardiogram) before and during treatment. A lifetime cumulative dose of doxorubicin is well-established.)

HM has been using prochlorperazine for nausea several times daily. She is 86 years old and frail. Which of the following statements is/are correct regarding prochlorperazine? (Select ALL that apply.) Answer A This drug can cause pseudo-parkinsonism. B This drug can cause significant QT prolongation. C The brand name is Complera. D This drug can cause strong anticholinergic side effects. E This drug is a dopamine receptor agonist.

A,B,D | Prochlorperazine (Compro, Compazine) is a dopamine receptor antagonist.

JP, a 46 year-old male (Ht. 6'2", Wt. 231 lbs, BSA 2.31 m^2) with colorectal cancer, is receiving the following chemotherapeutic regimen: ``` Oxaliplatin 85 mg/m2 IV on day 1 Leucovorin 400 mg/m2 IV on day 1 Fluorouracil 400 mg/m2 IV bolus after leucovorin on day 1, then 1,200 mg/m2/day x 2 days given via continuous IV infusion Bevacizumab 5 mg/kg IV on day 1 Repeat every 14 days Question ``` What is the bolus dose of leucovorin that should be dispensed for JP on day 1? Answer ``` A 196 mg B 400 mg C 800 mg D 924 mg E 1,116 mg ```

JP, a 46 year-old male (Ht. 6'2", Wt. 231 lbs, BSA 2.31 m^2) with colorectal cancer, is receiving the following chemotherapeutic regimen: ``` Oxaliplatin 85 mg/m2 IV on day 1 Leucovorin 400 mg/m2 IV on day 1 Fluorouracil 400 mg/m2 IV bolus after leucovorin on day 1, then 1,200 mg/m2/day x 2 days given via continuous IV infusion Bevacizumab 5 mg/kg IV on day 1 Repeat every 14 days Question ``` What is the total dose of fluorouracil JP receives every 14 days? Answer ``` A 400 mg B 3,696 mg C 5,544 mg D 6,468 mg E 8,584 mg ```

JP, a 46 year-old male (Ht. 6'2", Wt. 231 lbs, BSA 2.31 m^2) with colorectal cancer, is receiving the following chemotherapeutic regimen: ``` Oxaliplatin 85 mg/m2 IV on day 1 Leucovorin 400 mg/m2 IV on day 1 Fluorouracil 400 mg/m2 IV bolus after leucovorin on day 1, then 1,200 mg/m2/day x 2 days given via continuous IV infusion Bevacizumab 5 mg/kg IV on day 1 Repeat every 14 days Question ``` What is the total dose of bevacizumab JP receives every 14 days? Answer ``` A 11.5 mg B 411 mg C 525 mg D 924 mg E 1,155 mg ```

Which of the following screening tests are used to screen for colon cancer? (Select ALL that apply.) Answer ``` A Colonoscopy B Flexible sigmoidoscopy C Digital rectal exam D CT colonography E Double-contrast barium enema ```

A,B,D,E | The digital rectal exam is used to screen for prostate cancer.

FL is a male patient admitted to the hospital with chest pain, shortness of breath and worsening fatigue. He is newly diagnosed with stage IV small cell lung cancer with metastases to the liver and bone. After having several discussions with his oncologist, he expresses his desire to not undergo further work up or cancer treatment and states he would like to pass peacefully. What kind of therapy would be recommended for this patient? Answer ``` A Palliative therapy B Curative therapy C Adjuvant therapy D Targeted therapy E Neoadjuvant therapy ```

A patient with cancer has developed anemia, with a Hgb = 8.4 g/dL. The patient is receiving her 2nd of 4 monthly chemotherapy doses for cancer which is not considered curable. Which of the following medications could be used to increase the hemoglobin level? (Select ALL that apply.) Answer ``` A Neulasta B Procrit C Aranesp D Zarxio E Leukine ```

B,C | Epoetin alfa (Procrit) and darbepoetin (Aranesp) may be used to treat anemia in certain cancer patients.

MT is a 62 year-old female (64 inches, 71 kg) who has breast cancer and just completed cycle 2 of her AC regimen today. She had developed neutropenia after her first cycle of AC. Her labs 7 days after her first cycle of AC were: WBC 1,200 cells/mm^3, 30% segs and 2% bands. Which of the following would be an appropriate agent to prevent neutropenia this time and when should the medication be started? Answer ``` A Filgrastim starting tomorrow B Procrit starting tomorrow C Sargramostim starting today D Aranesp starting today E Fusilev starting in 72 hours ```

A | Filgrastim should be started no sooner than 24 hours after chemo.

What is the generic name of Neupogen? Answer ``` A Filgrastim B Pegfilgrastim C Sargramostim D Lomustine E Rolapitant ```

MT is a 62 year-old female (64 inches, 71 kg) who has breast cancer and just completed cycle 2 of her AC regimen today. She had developed neutropenia after her first cycle of AC. Her labs 7 days after her first cycle of AC were: WBC 1,200 cells/mm^3, 30% segs and 2% bands. A dose of Neulasta is ordered to be administered tomorrow. Which of the following statements regarding granulocyte colony stimulating factors (G-CSFs) is NOT correct? Answer A G-CSF is used to shorten the duration of neutropenia after chemotherapy. B Bone pain is a common side effect of filgrastim and pegfilgrastim. C The branded tbo-filgrastim product is called Granix. D The branded pegfilgrastim product is called Leukine. E Zarxio is a bioequivalent filgrastim product.

A patient is receiving cisplatin therapy. She may receive the following agent to reduce the risk of renal damage: Answer ``` A Mesnex B Zinecard C Procrit D Vistogard E Ethyol ```

E | Amifostine (Ethyol) may be used prophylactically to reduce the risk of renal toxicity.

In cancer patients, erythropoiesis-stimulating agents are rarely used to treat anemia due to which of the following concerns: (Select ALL that apply.) Answer ``` A Neutropenia B Shortened survival C Severe nausea and vomiting D Increased tumor progression in certain cancers E Drug contamination ```

B,D (Shortened survival and increased tumor progression have limited the use of ESAs in cancer patients. Cancer patients must meet the requirements of the ESA APPRISE Oncology Program (a REMS program) before receiving ESA treatment.)

What are the two indications of Zinecard and Totect, respectively? Answer A Treatment of doxorubicin-induced cardiomyopathy; treatment of anthracycline extravasation B Prophylaxis of doxorubicin-induced cardiomyopathy; treatment of anthracycline extravasation C Prophylaxis of trastuzumab-induced cardiomyopathy; prevention of anthracycline extravasation D Treatment of doxorubicin-induced extravasation; treatment of doxorubicin-induced cardiomyopathy E Prevention of doxorubicin-induced cardiomyopathy; prevention of anthracycline extravasation

B (Both contain dexrazoxane. Zinecard is used for prophylaxis of doxorubicin-induced cardiomyopathy, while Totect is used for the treatment of anthracycline extravasation.)

A pharmacist receives a prescription for Sancuso. Which drug should be dispensed? Answer ``` A Ondansetron B Granisetron C Dolasetron D Rolapitant E Netupitant ```

B | This is the patch formulation for granisetron.

Which of the following is the brand name for aprepitant? Answer ``` A Akynzeo B Emend C Varubi D Metozolv E Sustol ```

A pharmacist receives a prescription for Akynzeo. Which drug should be dispensed? Choose the generic name for this branded drug: Answer ``` A Ondansetron B Granisetron C Dolasetron D Palonosetron/Netupitant E Netupitant ```

A pharmacist receives a prescription for Zuplenz. Which drug should be dispensed? Answer ``` A Ondansetron B Granisetron C Dolasetron D Palonosetron/Netupitant E Netupitant ```

A | This is the ondansetron film formulation.

Which of the following chemotherapeutic medications is associated with the highest incidence of hand-foot syndrome? Answer ``` A Doxil B Ellence C Avastin D Adriamycin E Camptosar ```

A (Doxil and Lipodox50 are liposomal formulations of doxorubicin. These are associated with more hand-foot syndrome than the non-liposomal formulations.)

Which of the following chemotherapeutic agents is most likely to cause constipation? Answer ``` A Vincristine B Irinotecan C Capecitabine D Methotrexate E Trastuzumab ```

A | Vincristine is associated with autonomic neuropathy (causing constipation) as well as peripheral sensory neropathy.

Choose the correct statement/s concerning Zometa for the treatment of hypercalcemia of malignancy (Select ALL that apply.) Answer ``` A It starts working within 1-3 hours. B It is a bisphosphonate. C It is given intravenously. D It is dosed at 5 mg yearly. E The generic name is zoledronic acid. ```

B,C,E (IV bisphosphonates take at least 24 hours to start working for the treatment of hypercalcemia of malignancy and are usually combined with other treatments (e.g., fluid and diuretics). Reclast is dosed at 5 mg yearly for osteoporosis.)

Which of the following chemotherapeutic agents is associated with a > 90% frequency of emesis? Answer ``` A Fluorouracil B Irinotecan C Cisplatin D Oxaliplatin E Etoposide ```

Choose the correct name for a test used to screen for cervical cancer: Answer ``` A Pap test B Breast self-exam C Digital Rectal Exam D Colonoscopy E Fecal occult blood test ```

Hand-foot syndrome commonly occurs after treatment with which one of the following chemotherapeutic agents: Answer ``` A Epirubicin B Capecitabine C Cisplatin D Docetaxel E Vincristine ```

Choose the correct chemotherapeutic medication:adjunctive medication pair: Answer ``` A Ifosfamide:Amifostine B Cisplatin:Mesna C Methotrexate:Leucovorin D Docetaxel:Dexrazoxane E Fluorouracil:Atropine ```

C | Leucovorin is given with high-dose and sometimes moderate-dose methotrexate to reduce toxicity.

Mucositis is a well-known toxicity of which chemotherapeutic agent: Answer ``` A Asparaginase B Vincristine C Etoposide D Nilotinib E Methotrexate ```

E | Methotrexate carries a boxed warning for stomatitis, one form of mucositis.

JP, a 46 year-old male (Ht. 6'2", Wt. 231 lbs, BSA 2.31 m^2) with colorectal cancer, is receiving the following chemotherapeutic regimen: ``` Oxaliplatin 85 mg/m2 IV on day 1 Leucovorin 400 mg/m2 IV on day 1 Fluorouracil 400 mg/m2 IV bolus after leucovorin on day 1, then 1,200 mg/m2/day x 2 days given via continuous IV infusion Bevacizumab 5 mg/kg IV on day 1 Repeat every 14 days ``` Which medication in JP's regimen is associated with the most neuropathy? Answer ``` A Oxaliplatin B Leucovorin C Fluorouracil D Bevacizumab E All of the agents listed have the same incidence of neurotoxicity ```

A | Oxaliplatin, a platinum-based compound, is associated with the most neuropathy of the agents listed.

Which of the following statements regarding methotrexate is/are true? (Select ALL that apply.) Answer A Doses used for rheumatoid arthritis and are much lower than those used for cancer and are dosed once weekly, not daily. B Hydration and IV sodium bicarbonate are given to alkalinize the urine to reduce risk of nephrotoxicity. C Preservative-free formulations are used for intrathecal administration. D NSAIDs and salicylates can reduce the clearance, leading to methotrexate toxcity. E Glucarpidase administration is required following methotrexate to reduce toxicities.

A,B,C,D (Methotrexate (MTX) has many toxicities; alkalization of the urine helps to reduce nephrotoxicity. There are other (cheaper) agents to reduce MTX toxicities other than glucarpidase. NSAIDs and salicylates (as well as some other medications) can increase concentrations of MTX by reducing clearance.)

Which of the following medications contains a boxed warning that it can be fatal if given intrathecally? Answer ``` A Methotrexate B Vincristine C Cytarabine D Liposomal cytarabine E Irinotecan ```

B (Vincristine should ONLY be given intravenously. To avoid inadvertent intrathecal administration, doses should never be dispensed in a syringe.)

A pharmacist has a prescription for Xeloda. Which of the following is an appropriate generic substitution for Xeloda? Answer ``` A Etoposide B Capecitabine C Cabazitaxel D Erlotinib E Oxaliplatin ```

What is the rationale in using leucovorin? (Select ALL that apply.) Answer A To increase the clearance of doxorubicin. B To decrease the toxicity of methotrexate. C As an enzyme inhibitor to raise the concentration of drugs such as docetaxel. D To decrease the toxicity of cisplatin. E To increase the efficacy of drugs such as fluorouracil.

B,E (Leucovorin (or levoleucovorin) is an adjunct used in combination with other chemotherapy drugs to either enhance effectiveness, such as with flourouracil, or as a chemo-protectant/antidote to reduce the toxicity of methotrexate.)

A patient gave the pharmacist a prescription for Trexall. Which of the following should be dispensed? Answer ``` A Oxaliplatin B Carmustine C Thalidomide D Lenalidomide E Methotrexate ```

A pharmacist receives an order for Adriamycin. Which of the following should be dispensed? Answer ``` A Doxorubicin B Idarubicin C Epirubicin D Daunorubicin E Docetaxel ```

A pharmacist has a prescription for Gleevec. Which of the following is an appropriate generic substitution for Gleevec? Answer ``` A Sunitinib B Erlotinib C Nilotinib D Dasatinib E Imatinib ```

Which of the following is the appropriate chemotherapeutic agent and significant toxicity pair? Answer ``` A Doxorubicin: renal toxicity B Vinblastine: myelosuppression C Vincristine: myelosuppression D Cisplatin: hand-foot syndrome E Capecitabine: bladder toxicity ```

B | Vinblastine is myelosuppressive while vincristine is not

A 62 year old patient with lymphoma and an extensive cardiac history is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m^2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m^2 PO on days 1-5. Patient weighs 175 pounds and is 6'1" tall. Calculate the patient's BSA using the Mosteller Formula. Question Calculate the patient's BSA using the Mosteller Formula. Answer ``` A 1.27 B 1.85 C 2.02 D 2.74 E 3 ```

C (The Mosteller Formula = BSA (m^2)= SQR RT ([Height(cm) x Weight(kg)]/ 3600). Weight = 175 lbs, or 79.5 kg. Height = 6'1, or 73 inches which is 185.4 cm. BSA = 2.02)

A 62 year old patient with lymphoma and an extensive cardiac history is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m^2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m^2 PO on days 1-5. Patient weighs 175 pounds and is 6'1" tall. Calculate the patient's BSA using the Mosteller Formula. Question What is the most appropriate dose of cyclophosphamide for this patient? Answer ``` A 1,390 mg B 1,495 mg C 1,515 mg D 1,550 mg E 2,025 mg ```

C | Using the BSA of 2.02, the dose of cyclophosphamide would be 1,515 mg.

A 62 year old patient with lymphoma and an extensive cardiac history is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m^2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m^2 PO on days 1-5. Patient weighs 175 pounds and is 6'1" tall. Calculate the patient's BSA using the Mosteller Formula. Question What is the most appropriate dose of vincristine for this patient? Answer ``` A 1.5 mg B 2 mg C 2.5 mg D 3 mg E 4 mg ```

B (Using the BSA of 2.02, the dose would calculate out to 2.8 mg. However, the max single dose of vincristine is 2 mg due to the risk of neuropathy.)

Aromatase inhibitors are used to prevent breast cancer recurrence, but are poorly tolerated in many women. Choose the likely side effects from the use of aromatase inhibitors. (Select ALL that apply.) Answer ``` A Feeling weak and tired B Thrombocytopenia C Nausea and vomiting D Leukopenia E Hot flashes ```

A,C,E (These drugs cause significant lethargy and fatigue, hot flashes, nausea and vomiting. Aromatase inhibitors should not be taken along with tamoxifen or any form of estrogen.)

Arsenic trioxide, often used as second line therapy for acute promyelocytic leukemia, has which of the following boxed warning? Answer ``` A GI bleeding B Hypersensitivity reactions C Prolonged prothrombin time D QT prolongation E Neurotoxicity ```

TS is a 56 year-old male, 6'0" and 195 pounds, with a past medical history significant for hepatitis C virus, hypertension and chronic lower back pain and newly diagnosed non-Hodgkin's lymphoma. The medial team would like to start treatment today with the R-CHOP regimen which is below: ``` Rituximab 375 mg/m^2 on day 1 Cyclophosphamide 750 mg/m^2 IV on day 1 Doxorubicin 50 mg/m^2 IV on day 1 Vincristine 1.4 mg/m^2 IV on day 1 Prednisone 100 mg PO on days 1-5 Repeat every 21 days ``` Labs 10/21 WBC (4,000-11,000/mm^3) - 8,200 Hgb (12-18 g/dL) - 15.9% Question What should the patient's pharmacogenomics testing show in order to use rituximab? Answer ``` A Positive for B-cell antigen CD30 B Positive for B-cell antigen CD3 C Positive for B-cell antigen CD20 D Positive for B-cell antigen CD19 E Positive for B-cell antigen CD5 ```

TS is a 56 year-old male, 6'0" and 195 pounds, with a past medical history significant for hepatitis C virus, hypertension and chronic lower back pain and newly diagnosed non-Hodgkin's lymphoma. The medial team would like to start treatment today with the R-CHOP regimen which is below: ``` Rituximab 375 mg/m^2 on day 1 Cyclophosphamide 750 mg/m^2 IV on day 1 Doxorubicin 50 mg/m^2 IV on day 1 Vincristine 1.4 mg/m^2 IV on day 1 Prednisone 100 mg PO on days 1-5 Repeat every 21 days ``` Labs 10/21 WBC (4,000-11,000/mm^3) - 8,200 Hgb (12-18 g/dL) - 15.9% Question What is the dose of rituximab TS should receive? Answer ``` A 375 mg B 750 mg C 795 mg D 900 mg E 3,225 mg ```

C (The Mosteller Formula = BSA (m^2) = SQR RT ([Height(cm) x Weight(kg)]/ 3600). Wt = 195 lbs, or 88.6 kg. Ht = 6', or 72 inches which is 182.88 cm. BSA = 2.12 m^2. If use Dubois and Dubois, the BSA is 2.11. Rituximab dose is 375 mg/m^2 x 2.12 m^2 = 795 mg (or 791 mg if use Dubois and Dubois and the closest answer is still 795 mg).)

TS is a 56 year-old male, 6'0" and 195 pounds, with a past medical history significant for hepatitis C virus, hypertension and chronic lower back pain and newly diagnosed non-Hodgkin's lymphoma. The medial team would like to start treatment today with the R-CHOP regimen which is below: ``` Rituximab 375 mg/m^2 on day 1 Cyclophosphamide 750 mg/m^2 IV on day 1 Doxorubicin 50 mg/m^2 IV on day 1 Vincristine 1.4 mg/m^2 IV on day 1 Prednisone 100 mg PO on days 1-5 Repeat every 21 days ``` Labs 10/21 WBC (4,000-11,000/mm^3) - 8,200 Hgb (12-18 g/dL) - 15.9% Question On day 5 of the chemotherapeutic regimen, he complains of tingling, numbness and pain in his fingers. Which of his chemotherapeutic medications is most likely causing these symptoms? Answer ``` A Rituximab B Cyclophosphamide C Doxorubicin D Vincristine E Prednisone ```

TS is a 56 year-old male, 6'0" and 195 pounds, with a past medical history significant for hepatitis C virus, hypertension and chronic lower back pain and newly diagnosed non-Hodgkin's lymphoma. The medial team would like to start treatment today with the R-CHOP regimen which is below: ``` Rituximab 375 mg/m^2 on day 1 Cyclophosphamide 750 mg/m^2 IV on day 1 Doxorubicin 50 mg/m^2 IV on day 1 Vincristine 1.4 mg/m^2 IV on day 1 Prednisone 100 mg PO on days 1-5 Repeat every 21 days ``` Labs 10/21 WBC (4,000-11,000/mm^3) - 8,200 Hgb (12-18 g/dL) - 15.9% Question Based on the regimen above, what test should be monitored before and after treatment? Answer ``` A Echocardiogram B Audiogram C D-dimer test D Pulmonary function tests E Venous ultrasound ```

A (The left ventricular ejection fraction should be monitored using an echocardiogram before and after doxorubicin therapy to assess baseline function and monitor for cardiotoxicity.)

TS is a 56 year-old male, 6'0" and 195 pounds, with a past medical history significant for hepatitis C virus, hypertension and chronic lower back pain and newly diagnosed non-Hodgkin's lymphoma. The medial team would like to start treatment today with the R-CHOP regimen which is below: ``` Rituximab 375 mg/m^2 on day 1 Cyclophosphamide 750 mg/m^2 IV on day 1 Doxorubicin 50 mg/m^2 IV on day 1 Vincristine 1.4 mg/m^2 IV on day 1 Prednisone 100 mg PO on days 1-5 Repeat every 21 days ``` Labs 10/21 WBC (4,000-11,000/mm^3) - 8,200 Hgb (12-18 g/dL) - 15.9% Question TS has received 5 cycles of the above regimen. What is the total cumulative doxorubicin dose he has received to this point? Answer ``` A 250 mg B 415 mg C 530 mg D 600 mg E 630 mg ```

C | BSA = 2.12 m^2. 50 mg/m^2 x 2.12 m^2 x 5 cycles = 530 mg.

A patient gave the pharmacist a prescription for Femara. Which of the following is an appropriate generic substitution for Femara? Answer ``` A Letrozole B Flutamide C Bicalutamide D Anastrozole E Exemestane ```

JB has metastatic prostate cancer and he will begin leuprolide therapy. Which of the following statements regarding leuprolide is true? Answer A This medication should be used in combination with antiandrogen therapy. B This medication is taken orally, titrating up slowly over 1 month due to the risk of nausea. C The brand name is Zoladex D This medication can increase the risk of developing clots in the veins. E Monitoring with a DEXA scan is not needed

A (Leuprolide should be used with antiandrogen therapy to avoid tumor flare upon initiation in patients with metastatic prostate cancer.)

Which of the following agents is not an alkylating agent? Answer ``` A Cyclophosphamide B Fluorouracil C Carmustine D Melphalan E Ifosfamide ```

B | Fluorouracil is an anti-metabolite agent

ST is a 44 year-old female (Ht. 5'5" Wt. 48 kg, BSA 1.5 m^2) who is receiving the following chemotherapy regimen for breast cancer. She will not be undergoing any radiation as part of her treatment. ``` Doxorubicin 60 mg/m^2 IV on day 1 Cyclophosphamide 600 mg/m^2 on day 1 Zofran 16 mg IV prior to chemotherapy Dexamethasone 20 mg IV prior to chemotherapy Repeat cycles every 21 days for 4 cycles Question ``` ST is a 44 year-old female (Ht. 5'5" Wt. 48 kg, BSA 1.5 m^2) who is receiving the following chemotherapy regimen for breast cancer. She will not be undergoing any radiation as part of her treatment. Doxorubicin 60 mg/m2 IV on day 1 Cyclophosphamide 600 mg/m2 on day 1 Zofran 16 mg IV prior to chemotherapy Dexamethasone 20 mg IV prior to chemotherapy Repeat cycles every 21 days for 4 cycles Her daughter was alarmed when she notice that the patient's urine in the catheter bag looked red in color. Which of the following information is incorrect? Answer A Cyclophosphamide can cause the urine to be brown in color. B Mitoxantrone can cause the urine to be blue in color. C Propofol can cause the urine to be green in color. D Rifampin can cause the urine to be red in color. E Doxorubicin can cause the urine to be red in color.

A (Doxorubicin solutions are red in the bag and can cause discoloration of the body secretions, including urine, to the same color. Cyclophosphamide is not known to discolor the urine brown, but if hemorrhagic cystitis occurred, the urine could be red from blood.)

What is the maximum lifetime dose of bleomycin? Answer ``` A 200 units B 400 units C 550 units D 400 mg/m2 E 550 mg/m2 ```

A patient gave the pharmacist a prescription for Soltamox. Which of the following is an appropriate generic substitution? Answer ``` A Tamoxifen B Raloxifene C Bicalutamide D Anastrazole E Exemestane ```

Which of the following medications can cause pneumonitis and pulmonary fibrosis? (Select ALL that apply.) Answer ``` A Busulfan B Bleomycin C Cisplatin D Doxorubicin E Methotrexate ```

A,B,E

PS has breast cancer. She is receiving tamoxifen therapy. Choose the mechanism of action for tamoxifen: Answer ``` A Selective norepinephrine receptor modulator B Nonselective norepinephrine receptor modulator C Selective estrogen receptor modulator D Nonselective estrogen receptor modulator E Selective progestin receptor modulator ```

C (Selective estrogen receptor modulators, or SERMs, such as tamoxifen block estrogen in breast tissue and at other tissues, but can act as estrogen agonists elsewhere. They are used if the tumor is estrogen-receptor positive.)

A patient is receiving chemotherapy and her urine turns red. Which of the following chemotherapeutic agents can cause red urine? Answer ``` A Doxorubicin B Paclitaxel C Cytarabine D Fluorouracil E Mitoxantrone ```

A (Doxorubicin, idarubicin, daunorubicin, and epirubicin are all red in color and can discolor the urine with a pink-reddish tint up to 48 hours after treatment.)

A pre-menopausal woman with breast cancer (ER/PR+ and HER2+) has a prescription for Arimidex 1 mg PO daily. Which of the following is the correct action to be taken by the pharmacist? Answer ``` A Fill the prescription with anastrozole. B Fill the prescription with tamoxifen. C Do not fill since the patient is HER2+. D Do not fill since the patient is pre-menopausal. E Do not fill as this is the wrong dose. ```

D | Do not fill since the patient is pre-menopausal. Aromatase inhibitors are only approved for post-menopausal women.

What is the maximum single dose of vincristine? Answer ``` A 1 mg B 2 mg C 5 mg D 10 mg E 20 mg ```

B | Due to the risk of neuropathy, the maximum single dose of vincristine is 2 mg.

A pharmacist receives an order for Avastin. Which of the following should be dispensed? Answer ``` A Goserelin B Bicalutamide C Epirubicin D Bevacizumab E Trastuzumab ```

A patient is receiving doxorubicin chemotherapy. The patient has received a cumulative dose greater than 300 mg/m^2. The patient can receive which of the following agents to reduce the risk of heart damage: Answer ``` A Amifostine B Dexamethasone C Dexrazoxane D Deferoxamine E Deferasirox ```

C (With doxorubicin, dexrazoxane can be used to help reduce the risk of cardiotoxicity. It is used when the cumulative dose is greater than 300 mg/m^2.)

A patient is using IV methotrexate for cancer treatment. Choose the correct boxed warnings for methotrexate: (Select ALL that apply.) Answer ``` A Pancreatitis B Myelosuppression C Cardiac toxicity D Stomatitis and diarrhea E Pulmonary, hepatic and renal toxicity ```

B,D,E (Myelosuppression, stomatitis (also called oral mucositis) and lung/liver/kidney toxicity are all boxed warnings associated with methotrexate.)

A patient is receiving chemotherapy and her urine turns blue. Which of the following chemotherapeutic agents can cause blue urine? Answer ``` A Doxorubicin B Fulvestrant C Mitoxantrone D Etoposide E Dasatinib ```

C (Mitoxantrone is an anthracycline-like agent that is dark blue/purple in color and may discolor the urine to a bluish color.)

LP is a 44 year old female who is prescribed Revlimid as part of a regimen for treatment of diffuse large B cell lymphoma. Which of the following are required before she can receive this drug? Answer ``` A Echocardiogram B Urinalysis C Pregnancy test D Audiogram E Serum creatinine ```

C (Revlimid (lenalidomide) is an analog of thalidomide (available as Thalomid) and both of these drugs, along with pomalidomide (Pomalyst), are known teratogens that can cause severe birth defects. These drugs have REMS programs and pregnancy testing is required in females of childbearing potential.)

Which of the following chemotherapeutic drug classes are cell cycle non-specific? (Select ALL that apply.) Answer ``` A Anthracyclines B Vinca alkaloids C Alkylating Agents D Topoisomerase I inhibitors E Platinum-based agents ```

A,C,E (The alkylating agents, anthracycline agents and the platinum-based agents are all cell cycle non-specific in their activity.)

A patient is receiving ifosfamide therapy. The patient should receive the following agent(s) to reduce the risk of hemorrhagic cystitis: (Select ALL that apply.) Answer ``` A Mesna B Loop diuretics C Dexrazoxane D Hydration E Dimethyl sulfoxide ```

A,D (Mesna is given with all doses of ifosfamide. Aggressive hydration with fluids to flush the drug out of the bladder is also recommended to reduce the risk of this toxicity.)

A patient is receiving trastuzumab therapy. Choose the description that describes the patient's tumor: Answer ``` A BCR-ABL positive B ALK positive C Over-expresses HER2 D No KRAS mutations E EGRF positive ```

C | Trastuzumab should only be used if the tumor over-expresses HER2.

Which of the following represents the principal toxicities of cisplatin? (Select ALL that apply.) Answer ``` A Ototoxicity B Cardiotoxicity C Severe nausea and vomiting D Nephrotoxicity E Pulmonary toxicity ```

A,C,D

Which of the following oral medications needs to be refrigerated? Answer ``` A Erlotinib B Sunitinib C Etoposide D Imatinib E Nilotinib ```

C (When a capsule requires refrigeration (such as etoposide (VePesid capsules), it is important to know. We do not regularly refrigerate capsules and therefore it is easy for pharmacy staff to leave the product out of the refrigerator; this will ruin valuable medication.)

Which of the following represents a boxed warning and significant side effect of ifosfamide therapy? Answer ``` A Pulmonary toxicity B Bladder toxicity C Cardiotoxicity D Pancreatitis E Fatal rash ```

A pharmacist receives an order for Cytoxan. Which of the following should be dispensed? Answer ``` A Ifosfamide B Cyclophosphamide C Temozolomide D Bevacizumab E Cisplatin ```

A female patient is receiving capecitabine chemotherapy at a dose of 1,000 mg/m^2 PO BID x 14 days every 21 days. She weighs 128 pounds and is 5'5" tall. What is her BSA using the Mosteller Formula? Answer ``` A 1.5 B 1.63 C 1.93 D 2.23 E 2.42 ```

CC is a 68 year old female who is concerned about getting breast cancer. She is receiving raloxifene. Choose the common adverse effects from the use of raloxifene: (Select ALL that apply.) Answer ``` A Hot flashes B Hypotension C Osteoporosis D DVT or PE E Hyperglycemia ```

A,D (Raloxifene acts as an agonist at the estrogen receptors in the bone, improving bone density. Hot flashes and clotting risk are adverse effects. Raloxifene should be discontinued at least 72 hours before a prolonged immobilization (e.g., bed rest) and should used with extreme caution with long plane trips, or any situation where patients are not up and moving for a long period.)

Which of the following tests should be performed prior to cisplatin therapy? Answer ``` A Audiogram B Echocardiogram C Vision test D Pulmonary function tests E Liver function tests ```

A | Cisplatin can cause ototoxicity. Baseline and frequent audiograms are recommended

A pharmacist has filled a prescription for Femara. She should include the following points in her counseling to the patient: (Select ALL that apply.) Answer A Ensure adequate calcium intake. B Ensure adequate vitamin D supplementation. C Ensure adequate iron intake. D Get immediate help if the patient notices any new or worsening chest pain or becomes short of breath. E The patient may experience weakness, extreme fatigue and a desire to eat non-food substances such as paper. If this happens, report these symptoms immediately to a physician.

A,B,D | Femara decreases bone mineral density and has an increased risk for cardiac events.

Choose the correct mechanism of action for the aromatase inhibitors: Answer A Blocks the enzyme responsible for conversion of aroma to aromatase B Blocks the enzyme responsible for conversion to estrogen C Acts as an estrogen agonist in breast tissue D Blocks the estrogen receptor in breast tissue E Blocks androgen receptors

B (Aromatase inhibitors block aromatase, the enzyme responsible for conversion of androstenedione to estrone, and of testosterone to estradiol. Estrone and estradiol are estrogens.)

Rituximab carries a high risk of the following severe adverse reaction: Answer ``` A Nerve damage B Severe infusion reactions C Cardiotoxicity D Hepatotoxicity E Pulmonary toxicity ```

B | Infusion reactions from rituximab can be fatal; therefore, it is administered only in a medical setting.

SY is a 64 year-old female, (Ht. 5'2", Wt. 55 kg) with a past medical history significant for GERD, hypertension, hyperlipidemia and recently diagnosed metastatic colorectal cancer. She is at the infusion center and just completed cycle 1 of her regimen and is now complaining of sweating and diarrhea. She is receiving the following chemotherapeutic regimen: ``` Irinotecan 180 mg/m^2 IV on day 1 Leucovorin 400 mg/m^2 IV on day 1 Fluorouracil 400 mg/m^2 IV bolus after leucovorin on day 1, then 1,200 mg/m^2/day x 2 days given via continuous IV infusion Bevacizumab 5 mg/kg IV on day 1 Repeat every 14 days for 4 cycles Question ``` Which medication is most likely to cause the symptoms SY is complaining of now? Answer ``` A Irinotecan B Leucovorin C Fluorouracil D Bevacizumab E All of the agents listed have the same incidence of these symptoms ```

SY is a 64 year-old female, (Ht. 5'2", Wt. 55 kg) with a past medical history significant for GERD, hypertension, hyperlipidemia and recently diagnosed metastatic colorectal cancer. She is at the infusion center and just completed cycle 1 of her regimen and is now complaining of sweating and diarrhea. She is receiving the following chemotherapeutic regimen: ``` Irinotecan 180 mg/m^2 IV on day 1 Leucovorin 400 mg/m^2 IV on day 1 Fluorouracil 400 mg/m^2 IV bolus after leucovorin on day 1, then 1,200 mg/m^2/day x 2 days given via continuous IV infusion Bevacizumab 5 mg/kg IV on day 1 Repeat every 14 days for 4 cycles Question ``` Which medication should be recommended to treat SY's acute cholinergic symptoms? Answer ``` A Diphenhydramine B Codeine C Hydrocodone D Hydroxyzine E Atropine ```